CC BY
8PECULIARITIES OF CAPILLARIOSCOPIC INDICATORS OF NAIL BED AND STATUS OF THE MUCOSIUM CELL OF THE STOMACH AND DUODENUM IN CHILDREN WITH CHRONIC GASTRODUODENAL PATHOLOGY WITH CONCOMITANT ARTERIAL HYPERTENSION
Mikhieieva T.
Ph.D., assistant of the Department of Pediatrics, neonatology and perinatal medicine, Bukovinian State
Medical University, Chernivtsi Nechytailo D.
Ph.D., associate professor of the Department of Pediatrics, neonatology and perinatal medicine,
Bukovinian State Medical University, Chernivtsi
Abstract
One of the pathogenetic links in the development of chronic gastroduodenitis is dysfunction of the autonomic nervous system and microcirculatory disorders. Vegetative dysfunction lies at the heart of cardiovascular system disorders, in particular, in the regulation of blood pressure.
The purpose of our study was to study the features of capillaroscopic indices and the state of the mucous membrane of the stomach and duodenum in children with chronic gastroduodenal pathology and elevated blood pressure level in them.
We examined 80 school-age children diagnosed with chronic superficial gastroduodenitis, chronic erosive gastroduodenitis, chronic hyperplastic gastroduodenitis.
All children obtained: esophagogastroduodenofibroscopy with a macroscopic assessment of the mucous membrane of the stomach and duodenum, biomicroscopy of capillaries of the nail bed, tonometry. In 11% of children, hypertension was detected.
In children with chronic erosive and hyperplastic gastroduodenitis with concomitant arterial hypertension, microcirculatory disorders in capillaries of the nail bed and in the mucous membrane of the stomach and duodenum were more often observed than in children with chronic superficial gastroduodenitis.
The obtained results of studies testify to a clear correlation between changes in the microcirculatory bed of capillaries of the nail bed and vessels of the mucous membranes of the stomach and duodenum.
Keywords: children, chronic gastroduodenitis, microscopy of the capillaries of the nail bed, mucous membrane of the stomach and duodenum, arterial hypertension.
Among the chronic diseases of the digestive tract in children and adolescents, the pathology of the gas-troduodenal zone, in particular chronic gastroduodenitis (HGD), occupies a significant place [2, p. 33]. The medical and social significance of this problem is due to the magnitude of the spread of the disease, its recurrent progressive course, the possibility of developing severe complications, tolerance to the accepted methods of therapy, high probability of the formation of primary disability of adults [1, p. 21]. According to the results of epidemiological studies, the prevalence of diseases of the gastroduodenal zone in different regions of Ukraine is 140-150 per 1000 children population and tends to increase [2, p. 34].
HGD is a multifactorial disease in which the leading role belongs to the violation of the balance between the protective factors and the factors of aggression of the gastric mucosa (GM) and duodenal ulcer (DU) [5, p. 161].
According to the literature, the main line of protection for HGD includes adequate blood supply to the mucous membrane (MM). [5, p. 162]. Disturbance of blood supply to the MM leads to changes in the pH value of the stomach, damage to its structure, integrity and function [1, p. 23]. Normal blood circulation provides energy metabolic and reparative processes in MM [8, p. 188]. The state of the microcirculatory channel of the gastrointestinal tract has a high correlation with the state of microcirculation of the MM of the tuberous conyxivity and the nail bed [6, p. 106]. In the evaluation
of microcirculation in these areas, there are pathological changes in capillaries, identical to changes in the mucous membranes of the stomach and duodenum [6, p. 108].
One of the pathogenetic links in the development of HGD is the dysfunction of the autonomic nervous system, which, like microcirculatory disorders, leads to the development of diseases of the digestive tract [4, p. 48]. Vegetative dysfunction is also the basis of violations of the cardiovascular system, in particular, in the regulation of arterial pressure [3, p. 14]. Arterial hypertension is a common pathology in children of all ages [7, p. 872]. Disorders of neurohumoral regulation due to autonomic dysfunctions is also relevant for the study of the relationship between the clinical course of chronic gastroduodenal pathology and arterial hypertension in children [4, p. 48; 6, p. 110; 7, p. 878].
At present, the peculiarities of microcirculatory changes in GM and duodenal ulcer in children with HGD and arterial hypertension that have been able to approach individually prior to the appointment of treatment regimens in this pathology are not sufficiently studied [6, p. 108; 7, p. 877].
The aim of our study was to study the features of capillaroscopic indicators and the state of the mucous membrane of the stomach and duodenum in children with chronic gastroduodenal pathology and elevated blood pressure.
Material and methods. Were observed 80 children of school age, who were on inpatient treatment in the gastroenterology department of the city children's
clinical hospital in Chernivtsi with a diagnosis of chronic gastroduodenitis. The average age of children was 13.6 ± 0.11. The ratio of girls and boys is 1: 1. The structure of gastroduodenal pathology in the examined patients was as follows: 29 children (36.2%) with chronic superficial gastroduodenitis, 27 children (33.8%) with chronic erosive gastroduodenitis, and 24 (30.0%) with chronic hyperplastic gastroduodenitis. The verification of the diagnosis was carried out in accordance with the order of the Ministry of Health of Ukraine No. 59 dated January 29, "On the introduction of protocols for the treatment of children in the field of Pediatric Gastroenterology".
We used the following methods of research: an-thropometric, clinical, laboratory, instrumental, statistical.
All children were given esophagogastroduodeno-pyribroscopy, during which wasevaluated macroscopi-cally the state of GM and duodenal ulcer: the nature of the lesion (haemorrhagic, erosive, hyperplastic, etc.), color of the mucous membranes, edema, hemorrhage and stasis.
Microscopy of the capillaries of the nail bed in children was performed using a digital microscope with a 400-fold increase. The resulting images were stored and processed using a special program. Were evaluated perivascular, vascular and intravascular changes (presence or absence of local spasm, pathological humor, changes in the caliber of arterioles, venules, capillaries, and the phenomenon of "sladge" in them).
In children with erosive and hyperplastic lesions of the mucous membrane of the stomach and duodenum, changes in peripheral microcirculation were more likely to be observed than in children with chronic superficial gastroduodenitis.
When we performed the tonometry in the examined children, we obtained the following results: mean systolic blood pressure (SBP) was 123.2 ± 0.80 mm Hg. (maximum 98-162 mm Hg), the mean diastolic blood
Measurement of blood pressure was performed by mechanical tonometers with variable cuffs in the morning on both hands, three times, at intervals of 3 minutes between each measurement. The results were evaluated by percentile nomograms in relation to the age, sex and height of each child.
Data processing. Statistical processing of the data was carried out using non-parametric estimation methods. The mathematical processing of the data was performed using Microsoft Office Exсel and Statistica 6.1.
Discussion of received results. Characteristic of clinical features in the examined children were: abdominal pain, dyspepsia, appetite loss, vegetative changes and syndrome of chronic non-specific intoxication.
During endoscopic examination of the upper digestive tract in children, macroscopic evaluation of GM and duodenum mucosa was performed.
Thus, in children with chronic erosive and hyper-plastic gastroduodenitis, more severe violations of blood filling (hemorrhage and stasis of MM) were revealed, than in children with chronic superficial gastro-duodenitis.
All examined children were given biomicroscopy of the capillaries of the nail bed and assessed the state of microcirculation. Comparison of peripheral micro-circulatory changes in children with different forms of gastroduodenitis (Fig. 1).
pressure (DBP) was 78.8 ± 1.04 mm Hg (maximum 50105 mm Hg).
In children with chronic superficial gastroduodenitis in 2 children (6.9%), concomitant arterial hypertension was detected (their blood pressure was higher than the 95th percentile relative to gender, age and height of each child). In children with chronic erosive gastroduodenitis, 5 (20.8%) were found to have concomitant arterial hypertension, and among children with chronic erosive gastroduodenitis - 2 children
L5
% in
ne 10 r
rld ilh
c f
° 5 r
e
1
S 0
14
14
J?' <f ** J? ^
J> ¿Z ^ f
chr. superficial gastroduodenitis
chr. erosive gastroduodenitis
chr. hyperplastic gastroduodenitis
Fig. 1 Changes in capillaroscopic indices in children acoording to the nosology
(7.4%). In these children, the average SBP was 143.3 ± 2.72 mm Hg., average DBP - 94,0 ± 1,88 mm Hg.
The following changes were observed in children with arterial hypertension during capillaroscopy: 8 out of 9 children had abnormal morbidity of the capillaries, localized spasm and slowed down the blood flow in 9 children, the phenomenon of "sladge" in 7 children.
Correlation relations were observed between: the level of SBP (r = 0.86), and DBP (r = 0.90); between localized spasm and SBP level (r = 0.68); between the presence of the phenomenon of "sladge" in venules and the level of SBP (r = 0.72); the presence of hyperemia of GM with spasm of capillaries (r = 0.68, p <0.05). The presence of hemorrhages in GM had a high correlation with the presence of the phenomenon of "sladge" (r = 0.81, p <0.05). The presence of a stasis in GM correlated with the slowing of blood flow in the capillaries (r = 0.62, p <0.05), which can be regarded as the occurrence of congestive events in the microvessels.
Probably these changes are related to the common mechanisms of blood flow regulation due to the state of general blood supply and the state of microcirculation of capillaries. So, in the presence of hemorrhages in GM, most likely, hemorrhages will also occur in the capillaries of the nail bed, which will lead to a change in the color of the GM and pericarpillaries area of the nail bed.
Conclusions
1. Children with erosive and hyperplastic lesions of the mucous membrane of the stomach and duodenum were more likely to have observed a violation of blood filling than in children with chronic superficial gastro-duodenitis, which can be explained by more pronounced disorders of blood flow in this pathology.
2. Based on the data obtained, a clear relationship between changes in the microcirculatory channel of the mucous membranes of the stomach and duodenum on one side and the nail bed on the other is observed.
3. Children with chronic erosive and hyperplastic gastroduodenitis and arterial hypertension often exhibit symptoms of microcirculation disorder, which can be explained by the effect of autonomic disregulation, which in turn is accompanied by a violation of hemo-dynamics at all levels, including the capillary.
4. Microcirculatory disorders in the capillaries of the nail bed may be early signs of gastroduodenitis.
REFERENCES:
1. Beketova H.V. (2012). Khronichnyy hastro-duodenit u ditey i pidlitkiv: epidemiolohiya, etiolohiya, patohenez, diahnostyka. [Chronic gastroduodenitis in children and adolescents: epidemiology, etiology, path-ogenesis, diagnosis]. Sovremennaja pedyatryja. [Modern pediatrics], 6, 20-24.
2. Bobrova O.V, Pyankova N.I. (2012). Epide-miolohichni aspekty perebihu khronichnoyi hastroduo-denalnoyi patolohiyi u ditey. [Epidemiological aspects of the course of chronic gastroduodenal pathology in children]. Suchasna gastroenterologija. [Modern gas-troenterology], 2, 33-36.
3. Lychkovs'ka O.L. (2012). Osoblyvosti psyhoemocijnogo stanu ditej z patologijeju gastroduo-denal'noi' diljanky [Features of the emotional state of children with gastroduodenal pathology areas]. Acta Medica Leopoliensia [AML], 3, 12-18.
4. Pylypec' G.M. (2013). Stan vegetatyvnoi' nervovoi' systemy u ditej z hronichnym gastrytom i gastroduodenitom u period remisii' [State of the autonomic nervous system in children with chronic gastritis and gastroduodenitis in remission]. Suchasna gastroenterologija [Modern gastroenterology], 6 (38), 47-49.
5. Tyazhka O.V, Bobrova O.V. (2015). Vikovi morfolohichni osoblyvosti khronichnoho zapalennya slyzovoyi obolonky shlunka ta dvanadtsyatypaloyi kyshky. [Age-morphological features of chronic inflammation of the mucous membrane of the stomach and duodenum]. Sovremennaja pedyatryja. [Modern pediatrics], 5, 161-163.
6. Abdel-Salam O.M. (2015). Czimmer Gastric mucosal integrity: gastric mucosal blood flow and microcirculation. J. Physiol. 95(1), 105-127.
7. Bancalari R., Díaz C., Martínez-Aguayo A. (2014). Prevalence of hypertension in school age children and its association with obesity. Rev Med Chil, 139(7), 872-879.
8. Guyton A., Hall J. (2012). The Microcirculation and the Lymphatic System. In Gruliow Rebecca. Textbook of Medical Physiology. Philadelphia, Pennsylvania: Elsevier Inc., pp. 187-188.
