medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2022-035medsovet-7545Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESОсобенности язвенной болезни желудка и двенадцатиперстной кишки у больных с мезентериальным атеросклерозомFeatures of stomach and duodenum peptic ulcer in patients with mesenteric atherosclerosishttps://orcid.org/0000-0002-3481-8092СаенкоА. А.SaenkoA. A.

Саенко Анна Алексеевна, ассистент кафедры госпитальной терапии 

454092, Челябинск, ул. Воровского, д. 64

Anna A. Saenko, Assistant of the Department of Hospital Therapy 

64, Vorovskiy St., Chelyabinsk, 454092

anna-selyanina@mail.ruhttps://orcid.org/0000-0003-2569-1699ДолгушинаА. И.DolgushinaA. I.

Долгушина Анастасия Ильинична, д.м.н., доцент, заведующий кафедрой госпитальной терапии 

454092, Челябинск, ул. Воровского, д. 64

Anastasia I. Dolgushina, Dr. Sci. (Med.), Associate Professor, Head of the Department of Hospital Therapy 

64, Vorovskiy St., Chelyabinsk, 454092

dolgushinaai@yandex.ruhttps://orcid.org/0000-0001-5411-6437ФокинА. А.FokinA. A.

Фокин Алексей Анатольевич, д.м.н., профессор, заведующий кафедрой хирургии факультета дополнительного профессионального образования 

454092, Челябинск, ул. Воровского, д. 64

Alexey A. Fokin, Dr. Sci. (Med.), Professor, Head of the Surgery Department of the Additional Professional Education Faculty 

64, Vorovskiy St., Chelyabinsk, 454092

alanfokin@yandex.ruhttps://orcid.org/0000-0001-6327-2685ШамаеваТ. Н.ShamaevaT. N.

Шамаева Татьяна Николаевна, к.п.н., доцент кафедры математики, медицинской информатики, информатики и  статистики, физики

454092, Челябинск, ул. Воровского, д. 64

Tatyana N. Shamaeva, Cand. Sci. (Ped.), Associate Professor of the Mathematics, Medical Informatics, Computer Science and Statistics; Physics Department 

64, Vorovskiy St., Chelyabinsk, 454092

shamtan@rambler.ruhttps://orcid.org/0000-0001-5902-3803ГенкельВ. В.GenkelV. V.

Генкель Вадим Викторович, к.м.н., доцент, доцент кафедры пропедевтики внутренних болезней 

454092, Челябинск, ул. Воровского, д. 64

Vadim V. Genkel, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases 

64, Vorovskiy St., Chelyabinsk, 454092

henkel-07@mail.ruhttps://orcid.org/0000-0002-5082-5655ТарасовМ. В.TarasovM. V.

Тарасов Максим Владимирович, студент 6-го курса 

454092, Челябинск, ул. Воровского, д. 64

Maksim V. Tarasov, 6th year Student 

64, Vorovskiy St., Chelyabinsk, 454092

mxmtarasov12@gmail.comЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation202317052023084150Copyright © Саенко А.А., Долгушина А.И., Фокин А.А., Шамаева Т.Н., Генкель В.В., Тарасов М.В., 20232023Саенко А.А., Долгушина А.И., Фокин А.А., Шамаева Т.Н., Генкель В.В., Тарасов М.В.Saenko A.A., Dolgushina A.I., Fokin A.A., Shamaeva T.N., Genkel V.V., Tarasov M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7545

Введение. Высокая частота осложненных форм язвенной болезни (ЯБ) желудка и двенадцатиперстной кишки (ДПК) у пациентов с атеросклерозом требует изучения дополнительных факторов ульцерогенеза помимо инфекции Helicobacter pylori (H. pylori) и приема нестероидных противовоспалительных препаратов (НПВП). В настоящее время отсутствует четкое представление о роли атеросклероза мезентериальных артерий (МА) в развитии гастродуоденальных язв. Цель. Оценить вклад атеросклероза МА в развитие ЯБ желудка и ДПК у пациентов с мультифокальным атеросклерозом. Материалы и  методы. В  исследование был включен 91  пациент с  атеросклерозом двух и  более сосудистых бассейнов в период с 2019 по 2021 г. Обследование включало определение концентрации гастрина-17, пепсиногена I, пепсиногена II и антител к H. pylori IgG в сыворотке крови, а также проведение мультиспиральной компьютерной томоангиографии ветвей брюшной аорты и эзофагогастродуоденоскопии с гистологическим исследованием. Результаты. Пациенты были разделены на две группы: 1-я – 36 (39,6%) пациентов с ЯБ, 2-я – 55 (60,4%) больных без ЯБ. Отмечена большая частота гемодинамически значимых стенозов МА и более высокий процент стеноза верхней брыжеечной артерии  (ВБА) в  1-й  группе. Выявлена положительная корреляционная связь между выраженностью эрозивно-язвенного поражения и процентом стеноза ВБА, уровнями пепсиногена I и пепсиногена II. Сочетание ЯБ и атеросклероза МА характеризуется меньшей выраженностью абдоминального болевого синдрома (р = 0,049). Установлены факторы риска ЯБ: атеросклероз МА (ОШ 4,953; ДИ 1,571–15,608); более 8 баллов по шкале тревоги и депрессии HADS (ОШ 2,970; ДИ 1,062–8,320) и по опроснику Audit (ОШ 5,787; ДИ 1,348–24,837). Выводы. Атеросклероз МА является фактором риска ЯБ желудка и ДПК у  больных с  мультифокальным атеросклерозом. Гастродуоденальные язвы у пациентов с мезентериальным атеросклерозом характеризуются бессимптомностью течения.

Introduction. The high frequency of complicated forms of the stomach and duodenum peptic ulcer (PU) in patients with atherosclerosis requires the study of additional factors of ulcerogenesis in addition to infection with Helicobacter pylori (H. pylori) and the use of non-steroidal anti-inflammatory drugs (NSAIDs). Currently, there is no clear understanding of the role of mesenteric artery (MA) atherosclerosis in the development of gastroduodenal ulcers. The purpose of the study. To evaluate the contribution of MA atherosclerosis to the development of gastric and duodenal ulcer in patients with multifocal atherosclerosis. Material and methods. The study included 91 patients with atherosclerosis of two or more vascular beds in the period from 2019 to 2021. The examination included the determination of the gastrin-17, pepsinogen I, pepsinogen II and antibodies to H. pylori IgG concentration in blood serum, as well as multispiral computed tomoangiography of the abdominal aortic branches and esophagogastroduodenoscopy with histological examination. Results. The patients were divided into two groups: group I – 36 (39.6%) patients with PU, group II – 55 (60.4%) patients without PU. A more frequent occurrence of hemodynamically significant stenosis of the MA and a higher percentage of the superior mesenteric artery (SMA) stenosis in group I were noted. A positive correlation was found between the severity of erosive and ulcerative lesions and the percentage of SMA stenosis, levels of pepsinogen I and pepsinogen II. The combination of PU and MA atherosclerosis is characterized by a lesser severity of abdominal pain syndrome (p = 0.049). Risk factors for PU were identified: MA atherosclerosis (OR 4.953; CI 1.571–15.608); more than 8 points on the HADS depression scale (OR 2.970; CI 1.062–8.320) and on the Audit questionnaire (OR 5.787; CI 1.348–24.837). Conclusions. Risk factors for PU in patients with multifocal atherosclerosis were identified: MA atherosclerosis, subclinical depression, and health-threatening alcohol consumption. PU in patients with multifocal atherosclerosis is characterized by asymptomatic course.

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The authors declare that there are no conflicts of interest present.