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46«ШУУШШШУМ-ШИГМаУ» #9И6Ш, 2023 / MEDICAL SCIENCES
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УДК 616.33/.342-002.44-06:616.85
Honcharuk L.M
PhD in Medical Sciences, Associate Professor Department of Internal Medicine Bukovinian State Medical University;
Piddubna A.A.
PhD in Medical Sciences, Associate Professor Department of Clinical Immunology, allergology and endocrinology Bukovinian State Medical University;
Andrushchak M. PhD in Medical Sciences, Associate Professor Bukovinian State Medical University;
Panchuk V. 6th year student of 20 group Bukovinian State Medical University;
Skakun A.
6th year student of 20 group Bukovinian State Medical University; DOI: 10.24412/2520-6990-2023-9168-53-55 STRESS AND PEPTIC ULCER OF THE STOMACH AND DUODENUM
Abstract.
The article presents modern scientific data on the role of stress factors in the pathogenesis ofpeptic ulcer of the stomach and duodenum. The main theories of the development of this pathology are highlighted. The mechanisms of damage to the mucous barrier of the gastroduodenal zone due to a violation of vegetative regulation, depolymerization of mucoproteins of the mucous barrier of the stomach, activation of oxidative stress against the background of damage to the microcirculatory channel are described. These data prove the essential role of stress as a factor in ulcerogenesis.
Key words: stress, peptic ulcer of the stomach and duodenum;
One of the serious problems of modern society is stress. It is one of the main factors that cause many diseases. Scientists have proven that not too strong stress often mobilizes all our reserves and helps us achieve results and solve tasks quickly. However, if the stress is very strong and prolonged, the body begins to wear down, the nervous system suffers, and immunity decreases. The most common diseases caused by stress are heart and thyroid diseases, diabetes, psoriasis, peptic ulcers, hypertension, bronchial asthma, rheumatoid arthritis, obesity, eczema, depression, etc. In a broad scientific context, the term "stress" was first introduced into medicine by the Canadian physiologist Janos Selye in 1946.
Peptic ulcer (PU) of the stomach and duodenum is one of the most frequent diseases of the gastrointestinal tract. The prevalence of the disease is estimated at 510% of the adult population. The ratio of duodenal to gastric ulcer localization is 4:1. There are 5 million patients with PU registered in Ukraine. Over the past 15 years, an increase in the absolute and relative number of patients with a complicated course of duodenal ulcer has been registered by more than 2.5 times [1-4].
Peptic ulcer is a chronic recurrent polycyclic disease of the mucous membrane of the gastroduodenal zone with the formation of local erosive damage with a violation of the balance between the factors of "aggression" and "defense".
Gastric ulcer disease has very diverse symptoms. In different cases of the disease, individual patients may
have certain symptoms of the disease, possibly in combination, with different frequency of occurrence:
1. Painful sensations in the epigastrium with centralization to the midline of the abdomen. The pain syndrome is considered early in onset if it develops approximately one hour after eating; late - when it occurs three to four hours after eating; separate "hungry" pains that occur at night. A number of patients note pain in the morning before taking the first meal in the epigastric area or with significant breaks in eating. Taking alcoholic beverages in the vast majority of cases causes a pain attack;
2. For ninety percent of patients with gastric ulcer, heartburn is a common symptom;
3. Decreased appetite has a "protective" nature, as it were: the patient avoids eating so as not to provoke the onset of painful sensations;
4. Burping with the taste of acid and bitterness is often noted during the development of an ulcer;
5. An inconstant, but quite frequent sign is the radiation of pain in the navel and lower back. When such abdominal pain occurs, it is necessary to take into account the possibility of concomitant reactive cholecystitis and pancreatitis;
6. A feeling of fullness in the epigastric area, in some cases without a clear connection with eating;
7. An almost constant symptom of peptic ulcer disease is increased salivation and nausea. Vomiting is also observed in a number of cases, which sometimes leads to the disappearance of nausea and abdominal pain!
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MEDICAL SCIENCES / «COyyOMUM-JMTMaL» #9(168), 2023
Peptic ulcer disease is characterized by various dyspeptic disorders, increased gas formation (including concomitant pancreatitis), weight loss, and a whitish coating on the tongue.
The main theories of PU development [5]:
1. The theory of the duodenal-gastric reflex - the throwing of intestinal juice from the duodenum, which is alkaline, to the stomach, where the acidic environment prevails. Neutralization takes place with the release of a large amount of carbon dioxide, digestion processes in the stomach are disturbed.
2. The theory of reverse diffusion of hydrogen ions, that is, excessive acidity that damages the mucous membrane of the stomach.
3. Vascular theory (proposed by Virkhov) - when blood supply to organs of the gastrointestinal tract is disturbed, their tissues do not receive oxygen and nutrients, which causes atrophy, insufficiency of excretory glands, etc. Stress is part of the pathogenesis of the vascular theory.
4.The theory of medicinal gastritis is the use of drugs, especially non-selective non-steroidal anti-inflammatory drugs, which suppress cyclooxygenase, and this, in turn, suppresses the production of prosta-glandins responsible for the protection of the mucous membrane.
5. Alimentary theory - errors in nutrition, irregular eating, abuse of spices, overeating, etc.
6. Harmful habits - smoking and alcohol abuse. 95% of patients with PU are smokers, because nicotine causes hyperplasia of cells in the mucous membrane of the stomach, suppresses the formation of bicarbonate by the pancreas, increases the level of pepsinogen-1 in the blood and mucus formation in the stomach and duodenum, strengthens the motility of the stomach, leads to duodenogastric reflux.
7. Alcohol, in turn, damages the mucous barrier of the stomach, increases the back diffusion of H+ ions through the mucous membrane. Systematic alcohol consumption leads to dystrophy and/or atrophy of the gastric mucosa with the appearance of areas of intestinal metaplasia.
8. An infectious factor (Helicobacter pylori) can play a major role in the development of PU. It has been proven that approximately 80% of gastric ulcers and approximately 95% of duodenal ulcers are caused by Helicobacter pylori infection.
In recent years, there has been a renaissance in the study of the impact of psychological stress as an important factor in ulcer formation of the gastrointestinal tract, in the pathogenesis of which psychoemotional and psychosocial factors, such as physical (trauma, long-term pain syndrome) and psychological (fear, anxiety, insecurity, social maladaptation) play an important role, which are characterized by unpredictability and uncontrollability [4,6]. Stress can cause the appearance of any disease of the gastrointestinal tract, including autoimmune. At the same time, stress alone does not cause an ulcer. Other, more important factors are necessary for the development of this process. A key role in this is played by the hormones of the adrenal glands, which massively produce the hormone cortisol. Cortisol plays a key role in maintaining the body's daily
rhythms, regulating homeostasis, and adapting to environmental changes. During stress and anxiety, the body produces an excessive amount of cortisol, which leads to jumps in blood pressure, hot flashes, exacerbation of skin inflammation, etc. Elevated blood pressure against the background of stress occurs with persistent narrowing of blood vessels, including vessels that feed the organs of the abdominal cavity, which reduces the level of nutrition of tissues several times. And long-term stress causes the appearance of functional diseases and aggravation of already existing problems, which were previously only in the initial stages.In the implementation of the stressor response, the leading role belongs to the hypothalamic-reticular structures of the brain, which closely interact with the hippocampus and make up a single hypothalamic-pituitary-adrenocortical system, which directly affect the neuroendocrine regulation of the synthesis of biologically active substances, hydrochloric acid, microcirculation processes and immune protection of the mucous membrane. era of the gastrointestinal tract, motor function of the stomach. In the pathogenesis of PU, an important place belongs to autonomic dysfunction, which is characterized by reduced vagal activity against the background of increased tone of the sympathetic division of the auto-nomic nervous system, which contributes to the disruption of neurohumoral and neuromuscular activity of the stomach [4,7]. Stress ulcers, as a rule, have a number of differences from ordinary peptic ulcers. Stress ulcers, as a rule, are small in size and do not show signs of chronicity. They can be single or multiple, localized in the body and the bottom of the stomach. Stress ulcers also have differences in the pathogenesis of their development. The mechanism has not been fully elucidated. The main pathogenetic links of the formation of stress ulcers: ischemia of the gastric mucosa, increased production of hydrochloric acid, decreased secretion of bicarbonate [8].
Stress is a protective reaction of the body to external stimuli. It manifests itself mentally, physically, emotionally and allows you to adapt to changes. Primary prevention of peptic ulcer is aimed at improving nutrition, improving conditions and quality of life. Secondary prevention involves anti-relapse treatment of peptic ulcer using modern anti-secretory drugs in optimal doses and avoiding stressful situations.
Referenses.
1. Nakaz MOZ Ukrayiny № 613 vid 03.09.2014 «Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) medychnoyi dopomohy «Peptychna vyrazka shlunka ta dvanadtsyatypaloyi kyshky». - K., 2014. - 30 s.
2. Levenstein S. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs / S. Levenstein, S. Rosenstock, R.K. Jacobsen [et al.] // Clinical Gastroenterology and Hepatology. -2015. - Vol. 13. - P. 498-506.
3. Modlin I.M. Acid-related diseases: biology and treatment / I.M. Modlin, G. Sachs. - Philadelphia, 2004. - 538 p.
4. Skrypnyk I.M. ta in. Rol stresu v patohenezi peptychnoi vyrazky hastroduodenalnoi zony / I.M.
«COyyOMUM-JMTMaL» #9(168), 2023 / MEDICAL SCIENCES
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Skrypnyk, K.S. Neporada, O.F. Hopko // Visnyk problem biolohii i medytsyny - 2017 - Vyp. 4, tom 1 (139). - c.70-73.
5. Snihyr N.V., Sabadash V.Ye. Rol helicobacter pylori v etiopatohenezi khvorob shlunkovo-kyshkovoho traktu / N.V. Snihyr, V.Ye. Sabadash // Liky Ukrainy. - Medicine of Ukraine. - 2019. - №2 (228).- s. 12-15.
6. Melinder C. Decreased stress resilience in young men significantly increases the of subsequent peptic ulcer disease - a prospective study of 233 093
men in Sweden / C. Melinder // Aliment. Pharmacol. Ther. - 2015. - Vol. 41 (10). - P. 1005-1015.
7. Bhatia V. Stress and the gastrointestinal tract / V. Bhatia, R.K. Tandon // J. of Gastroenterology and Hepatology. - 2005. - Vol. 20 (3). - P. 332-339.
8. Iskra Yu., Biliaiev A. Chastota stresovykh vyrazok i yikh zalezhnist vid kyslotnosti shlunkovoho vmistu v peryoperatsiinyi period u ditei /Iu. Iskra, A. Biliaiev // Ukrainskyi naukovo-medychnyi molodizhnyi zhurnal. - 2017. - №1(99). - S.31-36.
UDC:616.932-07:355.01(477)
Melenko Svitlana Romanivna
PhD, Associate Professor of the Department of Infectious Diseases and Epidemiology
Bukovinian State Medical University Klym Lidiia Olexandrivna student
Bukovinian State Medical University
Zapotochna Viktoria Olexandrivna
student
Bukovinian State Medical University DOI: 10.24412/2520-6990-2023-9168-55-58 CHOLERA AND THE ONGOING WAR
Abstract.
During military operations, for a number of reasons, such as deterioration in the quality of drinking water, inadequate compliance with sanitary standards due to the occupation of territories, etc. Among the acute intestinal infections, cholera outbreaks pose a great danger. The issue ofprevention of acute infectious diseases is urgent.
Keywords. Cholera, vibrion cholera, war, pandemic, seven cholera pandemics, Ukrainian cases of cholera
Introduction. According to the International Health Regulations (IHR) 2005, due to the ease of infection, high rate of spread, severe course, and high mortality, cholera is an infectious disease that significantly affects public health and can spread rapidly on an international scale.
Cholera has plagued humans for hundreds, if not thousands, of years, particularly in the areas around the Bay of Bengal, with some of the first records of cholera-like illness reported in ancient Sanskrit medical texts written around 500-400 BCE[1]. One of the first descriptions of cholera dates back to the campaigns of Alexander the Great, whose soldiers probably suffered from the disease during an Indian campaign. One source describes the patient's condition as follows: "The lips turn pale, the gaze becomes meaningless, the eyes roll back, the arms and legs shrivel as if by fire, and the disease affects many thousands of people."
Favorable conditions for the spread of the disease include a hot climate, high rainfall, the presence of water bodies contaminated with feces, and high population density. The peculiarities of India as the primary center of cholera "preserved" the disease without significant changes until the nineteenth century. However, since the 1800s, the spread of cholera has suddenly and tragically for humanity become a pandemic, which has been recorded since 1817. The reasons for this rapid spread of the disease are the explosive growth of international trade, numerous colonial wars, and significant migration.
Since then, cholera has become a pandemic. The first pandemic (1817-1824) began in India during the colonial war and spread to neighboring regions of India - China, Ceylon, and then to Japan. In 1820, the disease was discovered in East Africa. The following year, the British brought it to Arabia, then to Persia, Turkey, and the Transcaucasus[2].
II pandemic (1826-1851)
In 1826-1828, the disease spread east of India, to China, Indochina, and northwest to Afghanistan, Khiva, and Bukhara[3]. Meanwhile, in 1830, the disease made its way to the Middle East. Up to 150 thousand people died in Egypt. During the Russo-Polish War of 1830-1831, more than 12 thousand soldiers died of cholera in the Russian army alone. The following year, French colonial troops introduced cholera to Africa, and emigrants to North America and Australia[4]. In the Russian Empire, 534,000 people fell ill with cholera in two years, and 230,000 died. Cholera appeared in Central and Western Europe in 1831. The disease pandemic spread to all continents. In 1848, 60-100 soldiers died of cholera every day in the Russian army of Field Marshal Paskevich in Galicia[3].
III pandemic (1852-1860)
From India, the spread of cholera to Persia was associated (and later it happened often) with the Shiite pilgrimage to the sacred graves of Kerbala and Najaf. Cholera was brought to Arabia by pilgrims traveling to the Muslim shrines in Mecca and Medina[2]. In those years, there were problems with water stored in con-
