2014


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2014/№6

Clinico-morphological and pathogenetic features of erosive-ulcerous gastroduodenal lesions in patients with different severity of chronic heart failure associated with ischemic heart disease

Osadchiy V. A., Bukanova T. Yu.
State Budgetary Educational Institution of Higher Professional Education “Tver State Medical Academy” of the RF Ministry of Health Care, Sovetskaya 4, Tver 170100

Keywords: gastroduodenal area, CHF, erosive-ulcerous lesions


DOI: 10.18087/rhfj.2014.6.2004

Background. Gastroduodenal erosions and ulcers are among the most common and severe extracardiac abnormalities associated with CHF. Aim. To identify clinico-morphological features of gastroduodenal erosive-ulcerous lesions in patients with CHF of different severity combined with IHD, and to evaluate the role of local and systemic pathophysiological reactions in development of these lesions. Materials and methods. 65 CHF patients with gastroduodenal erosions and ulcers were evaluated and divided into two groups based on CHF severity. The state of gastroduodenal mucosal microcirculation, hemostasis, and gastric secretion was evaluated. Results. The incidence of acute erosions was higher in I–IIA stage CHF. Clinical presentation of these erosions was characterized by a combination of episodic, vague abdominal pain and dyspepsia. Relapse of peptic ulcerous disease was generally associated with solitary, medium-size antral or duodenal cup surface ulcerations, which declared themselves as persistent pain with a diurnal rhythm typical for the antroduodenal location of ulcers. IIB-III stage CHF was also associated with acute erosions evident as multiple, often medium-size defects, which occupied large areas of the mucosa in the gastric body or antrum and the duodenal cup. Relapse of peptic ulcerous disease was associated with large and deep solitary medio-gastric or antro-duodenal ulcers, often with signs of stopped microhemorrhage. Persistent dyspepsia and moderate abdominal pain were the major clinical signs of erosions and ulcers in this group. The ulcerous process was associated with symptoms of non-massive gastrointestinal bleeding in approximately one third of cases. The development of CHF-associated acute erosions and relapse of peptic ulcerous disease was based on focal thrombo-hemorrhagic disorders of mucosal microcirculation. In I–IIA stage CHF, these disorders were associated with changes in hemostasis characteristic of hypercoagulation, and in IIB-III stage CHF – with consumption coagulopathy. Conclusion. Clinico-morphological and pathogenetic features of gastroduodenal erosions and ulcers in CHF are determined by CHF severity, which should be taken into account in administration of diagnostic and therapeutic actions.
  1. Арбузова В. Г., Логинов А. С., Звенигородская Л. А. и др. Особен­­ности патогенеза и клинического течения язвенной болезни у больных хронической недостаточностью кровообращения. Российский гастроэнтерологический журнал. 1995;4:9–13.
  2. Белобородова Э. И. Состояние желудка и тонкой кишки при застойной сердечной недостаточности и гипоксии. Дис. … д-ра мед. наук. – Томск, 1983.
  3. Бойко А. Н. Эффект тиотриазолина и состояние слизистой оболочки желудка при Helicobacter pylori-негативных гастропатиях у больных хронической сердечной недостаточностью. Международный медицинский журнал. 2011;17 (4):25–30.
  4. Raja K, Kochhar R, Sethy PK et al. An endoscopic study of upper-GI mucosal changes in patients with congestive heart failure. Gastrointest Endosc. 2004 Dec;60 (6):887–93.
  5. Silverberg DS, Wexler D, Iaina A, Schwartz D. The role of correction of anemia in patients with congestive heart failure: a short review. Eur J Heart Fail. 2008 Sep;10 (9):819–23.
  6. Русская Л. В. Желудочно-кишечные кровотечения у больных с хронической сердечной недостаточностью и сочетанной патологией. Российский кардиологический журнал. 2008;12 (5):31–6.
  7. McGee MF, Rosen MJ, Ponsky JL. Management of acute gastrointestinal hemorrhage. Adv Surg. 2006;40:119–58.
  8. Решетников О. В., Курилович С. А., Вязигин Е. А., Копычко Т. А. Трудности дифференциальной диагностики язвенной болезни и ишемической болезни сердца. Клиническая медицина. 1999;77 (4):52–4.
  9. Tseng PH, Liou JM, Lee YC et al. Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease. Am J Emerg Med. 2009 Sep;27 (7):802–9.
  10. Chow DK, Sung JJ. Non-NSAID non-H.pylori ulcer disease. Best Pract Res Clin Gastroenterol. 2009;23 (1):3–9.
  11. Лазебник Л. Б., Дроздов В. Н. Заболевания органов пищеварения у пожилых. – М.: Анахарсис, 2003. – 208с.
  12. Verhamme K, Mosis G, Dieleman J et al. Spironolactone and risk of upper gastrointestinal events: population based case-control study. BMJ. 2006 Aug;333 (7563):330.
Osadchiy V. A., Bukanova T. Yu. Clinico-morphological and pathogenetic features of erosive-ulcerous gastroduodenal lesions in patients with different severity of chronic heart failure associated with ischemic heart disea. Russian Heart Failure Journal. 2014;15 (6):374–381

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