[Substantiation of empiric eradication therapy in patients with duodenal ulcer].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to S I Pimanov.
Explore the source record for details and available documents.
AIM: To study trends in morphological changes of gastric mucosa (GM) and its functional characteristics (serum gastrin-17, pepsinogens I and II) in eradication of Helicobacter pylori (HP) in patients with duodenal ulcer (DU). MATERIAL AND METHODS: HP infection was detected with a rapid urease test, morphological study of gastrobiopsies and polymerase chain reaction in 59 patients with DU. The results of HP eradication were assessed two months after the treatment. Morphological study of gastrobiopsies, assays for gastrin-17, pepsinogens I and II in blood serum were made before the treatment and one year after HP eradication. RESULTS: By the results of eradication two groups were formed: with effective eradication and uneffective eradication of H. pylori. Examination of GM one year after successful H. pylori eradication in DU patients GM inflammation relieved: reduction in polymorphonuclear (by 42.6%), mononuclear (by 29.3%) infiltration and number of lymphocytic follicules (16.8-fold). GM atrophy decreased by 47.8%. In patients with uneffective eradication the above positive changes were not registered. After H. pylori eradication, serum gastrin-17 lowered by 46. 7%, pepsinogen I--by 30.5%, pepsinogen II--by 36.9%. In uneffective eradication this decrease did not occur. CONCLUSION: H. pylori eradication leads to positive changes in morphological and functional indices reflecting GM condition.
Classifications of chronic gastritis and neoplastic gastric diseases, developed in recent years (1996 Houston update of 1990 Sidney classification system, 2002 New Orlean classification of atrophic gastritis according to recommendations of International Group for Atrophy Studies; 1998 Padova classification of gastric displasia, and 1998 Vienna classification of gastrointestinal neoplasia) allow to statandardize international research and perform more objective diagnostics of pathological changes in the gastric mucosa. Studies carried out in recent years have established that morphological manifestations of chronic gastritis caused by Helicobacter pylori infection can be reduced after its eradication. Longterm treatment with proton pump inhibitors have been demonstrated not to cause atrophic changes in the gastric mucosa when undertaken after successful eradicational therapy. It has been established that corporal gastritis intensifies in patients treated with proton pump inhibitors. The studies show that measurement of serum levels of Helicobacter pylori antibodies, gastrine, pepsinogen I and II can be used in non-invasive serologic diagnostics of atrophic gastritis. Achievements in diagnostics and treatment of chronic gastritis create the necessary prerequisites for the development of gastric cancer preventing measures.
Explore the source record for details and available documents.
The paper presents the results of an examination of 269 patients (including 205 males and 64 females) aged 18-62 years who had gastroduodenal ulcers; amongst them, 137 and 132 patients were treated in the in- and out-patient settings, respectively. It was ascertained that the pathomorphism of the clinical picture of peptic ulcer had occurred. About a third of all the exacerbations became asymptomatic or displayed few symptoms. In patients with duodenal ulcer, the epigastrium rather than the right hypochondrium is the most common site of pain on an exacerbation.
The method and semeiotics of noninvasive ultrasonic diagnosis of pyloroduodenal stenosis are described. Seventy-six patients with duodenal ulcer and 13 patients with gastric ulcer were examined, and also 18 patients with gastric carcinoma and 24 healthy individuals. The echographic picture of an empty stomach in compensated pyloroduodenal stenosis did not differ from that in healthy persons, though study of the motor-evacuation activity of the stomach revealed intensified peristalsis and increased gastric half-evacuation period. In subcompensated pyloroduodenal stenosis the stomach contained fluid and the period of half-evacuation of its contents was sharply increased. All patients with decompensated pyloroduodenal stenosis had an increased volume of the stomach which contained much fluid and food remnants. Pyloric spasm was differentiated by means of the spasmolytics test. Patients with a marked periulcerous inflammatory infiltration must be kept under dynamic follow-up to evaluate the degree of the stenosis. Taking into consideration the peculiarity of the echographic picture of the pyloric part, the neoplastic character of the pyloroduodenal stenosis may be presumed with high precision.
Explore the source record for details and available documents.
A method for abdominal ultrasonographic diagnosis of gastric cancer is suggested which includes evaluation of the gastric wall and regional lymph nodes, and search for distant metastases. Gastric tumors were visualized in 92.9% of cases. The procedure should be performed both in cancer suspects and cases with reliably established gastric neoplasm to assess local extent of tumor and detect regional and distant metastases.
A method of ultrasound diagnosis of duodenogastric reflux was developed. It enables the reflux identification with a high accuracy. It is suggested that 3 grades of the intensity of echographically recordable duodenogastric reflux may be distinguished. The method enables an individual estimation of the action efficacy and the choice of an adequate dose of pharmacological agents, particularly metoclopramide, for the treatment of duodenogastric reflux.
A method for ultrasonic examination of gastric motor evacuatory function, available for clinical practice, has been developed. Results of parallel estimation of the gastric contents half-life period by the ultrasonic and scintigraphic techniques evidence a high accuracy of the suggested method of echographic estimation of gastric function. Accelerated evacuation of the gastric contents was revealed in patients with duodenal ulcer without ++pyloric stenosis++.
To raise the accuracy of ultrasonic diagnosis of chronic cholecystitis, it is suggested that the choleretic test designed by the author may be used, making it possible to study gallbladder extensibility. As many as 124 patients with chronic cholecystitis and 50 healthy persons were examined. In 63 patients, the diagnosis was verified morphologically after cholecystectomies. Chronic cholecystitis patients demonstrated the lowering of gallbladder extensibility, especially after atropine administration preceded by the use of dehydrocholic acid. Echography with the use of the choleretic test considerably raises the accuracy, efficacy, specificity and sensitivity of ultrasonic diagnosis of chronic cholecystitis.
Gallbladder contractility was assessed using ultrasound in 111 patients with biliary pathology and 34 normal controls. The original and literature data show that food stimulus-induced contractility of the gallbladder is related to the pattern of gastric evacuation, duodenal mucosa status, nervous regulation, morphological inflammatory and sclerotic lesions in the gallbladder wall. Echographic evaluation of motor-evacuatory function of the stomach contributes to more accurate interpretation of the contractility. Hypotonic biliary dyskinesia is thought nonidentical to hypomotor dyskinesia. These disorders reflect different aspects of gallbladder dysfunction.
Explore the source record for details and available documents.
Results of an analysis of causes of the absence of contrast of the gallbladder in preoperative radiopaque examinations are presented. In most cases the exclusion of the gallbladder was due to cholelithic disease. The ultrasonic echotomography in some cases associated with a choleretic test allows to considerably facilitate and improve the diagnosis of the excluded gallbladder.
The authors provide the results of repeated echography of the gall bladder after the use of choleretics in cases presenting difficulties for echographic diagnosis of concrements inside the organ. Describe the technique of making the choleretic test, define indications and contraindications as to its use. Ultrasonic exploration of the gall bladder after choleretic intake raises the accuracy of echographic diagnosis of cholelithiasis, reduces the time required for echocholecystography, helps make differential diagnosis of the gall bladder diseases.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The purpose of the study was to examine gastric mucosal morphological changes in patients with gastroduodenal pathology after eradication therapy for Helicobacter pylori (H. pylori). A hundred and thirty-eight patients (40 females and 98 males) were examined. Of them, there were 122 patients with duodenal peptic ulcer, 8 with gastric peptic ulcer, 5 with erosive gastritis, 2 with chronic atrophic antral gastritis, and 1 with non-atrophic gastritis. Two months and a year after therapy, manifestations of gastric mucosal atrophy, the degree of inflammation, and its activity significantly diminished in patients with complete H. pylori eradication. Positive changes were observed mainly in the antral portion of the stomach. In patients with partial eradication, chronic inflammation and its activity became less. Two months and a year following therapy, positive changes in the gastric mucosa were absent in patients without H. pylori eradication.