Blood flow and pathology of the gastroduodenal mucosa in patients with combination of chronic pancreatitis and gastroesophageal reflux disease: results of a comparative study


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Abstract

Purpose. Assessment of regional blood flow in the mucous membrane (MM) of the body, antral part of the stomach, and duodenum in patients with a combination of chronic pancreatitis (CP) and gastroesophageal reflux disease (GERD), depending on gastroduodenal motor activity, morphological changes in gastroduodenal MM and patient’s age. Material and Methods. The study included 41 patients (27 males and 14 females) aged 20 to 64 years with CP in combination with GERD, and 25 healthy controls (15 males and 10 females) aged 22 to 46 years. All patients underwent assessment of exocrine and endocrine functions of the pancreas, esophagogastroduodenoscopy with body biopsy of the MM of the body, antral part of the stomach and duodenal bulb. Morphological state of MM was assessed in sections stained with hematoxylin and eosin. The gastroduodenal mucosal blood flow velocity was measured by the polarographic method. Comparative assessment of gastroduodenal mucosal blood flow and gastroduodenal motility was conducted in 23 patients. Results. Analysis of the histological findings of patients with a combination of CP and GERD compared with control group has revealed a significant predominance of lymphoplasmocytic infiltration, gastric metaplasia and glandular atrophy in duodenal MM, as well as a significant decrease in villous height, especially in persons over 50 years of age. Morphological changes in the MM of the duodenal bulb in patients were accompanied by a significant decrease in the blood flow velocity (by 26.2%) compared to persons with unchanged MM. There was also a significant increase in the mucosal blood flow velocity (by 1.5-1.7 times) in the phase of motor activity in comparison with the phase of motor resting in all patients in all parts of gastroduodenal MM. Conclusion. These data indicate that in patients with CP in combination with GERD or NERD histological changes in gastroduodenal MM were accompanied by a decrease in the mucosal blood flow velocity associated with glandular atrophy of the body and antrum of the stomach, more pronounced in patients older than 50 years, in comparison with healthy controls. Also, the possibility of electrochemical registration of gastroduodenal motor activity by the character of polarographic curves of hydrogen clearance reflecting the mucosal blood flow velocity is confirmed. The observed cohe-rent changes in gastroduodenal motor activity and the mucosal blood flow velocity reasonably suggest their associated drug correction.

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About the authors

V. V Gorban

Kuban State Medical University

Email: gorbanvv@mail.ru
MD, Head of the Department of Polyclinic Therapy with the Course of GMP (FM) FATPRS

N. V Korochanskaya

Kuban State Medical University

E. V Gorban

Kuban State Medical University

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