Disbalance between aggressive acidic and peptic gastric contents and mucous tunic cytoprotective function is considered in gastric and duodenal H. pylori associated ulceration
Disbalance between aggressive acidic and peptic gastric contents and mucous tunic cytoprotective function is considered in gastric and duodenal H. pylori associated ulceration. The objective. To study the specifics of ultrastructural changes in mucosal membrane of stomach and duodenum, during the severe peptic ulcer disease, on the basis of which to develop recommendations for optimization of treatment for this group of patients. Materials and methods. Gastroduodenoscopy with gastric mucous tunic biopsy, quick urease test, electronic and light microscopy studying of gastric and duodenal mucous tunic biopsy material, evaluation of H. pylori antigen in stool, detection DNA of H.pylori in biopsy material performed in 67 patients with severe and complicated gastric and duodenal peptic ulcer. Modified sequential and standard triple H. pylori eradication therapy used. Results and discussion. High level mononuclear and neutrophilic infiltration in gastroduodenal mucous tunic and ultrastructural changes of epithelial cell and vessels in proper mucous plate are registered. H. pylori eradication is attained in 91% of patients. Organells endothelial cells changes with different intensity remained after antiulcer and H. pylori eradication therapy. Conclusion. Electronic microscopy changes in epithelial and endothelial cells proved the deep tissue damage in subcellular mucous tunic levels. Using of bismuth tripotassium dicitrate, which provide required level of prostaglandins and carbon dioxide to improve microcirculation is reasonable in no less than 4-week composite therapy.