Functional features and efficiency of acid suppression in patients with duodenal peptic ulcer who underwent the ulcer perforation
Aim of the study: Comparison of features of acid formation and alkalinization in the stomach, of the results of standard antisecretory therapy in patients with duodenal peptic ulcer (DPU) who underwent in their anamnesis the ulcer perforation with the patients with uncomplicated disease course. Materials and methods. 113 patients with DPU reccurence phase were examined, the 1-st group included 61 patients who had uncomplicated DPU course, the 2-nd group - 52 patients who had ulcer perforation in their anamnesis. In all patients esophagogastroduodenoscopy, respiratory urease test, daily intragastric monitoring of pH before treatment administration and on the 5-th day of standard therapy were performed. Endoscopic dynamics of the ulcer defect cicatrisation was evaluated. Results: In complicated course acidity in the gastric body was higher and monotonic over circadian period than in uncomplicated DPU. Decompensation of antral alkalinization was also more severe in the 2-nd group. Sufficient effect of antisecretory therapy was noted in 88,5% of patients with uncomplicated DPU course and in 73% - with perforation in the anamneses. In 14 day scarring of the ulcer was observed in 91,8% and in 75% of cases respectively. Conclusions: High and monotonic fundal hyperacidity, marked inhibition of duodenogastral reflux and severe decompensation of antral alkalinization were characteristic of DPU patients who underwent the ulcer perforation. With these, standard doses of omeprazole were ineffective in a quarter of patients who underwent perforation and this is accompanied by significant increase of the terms of scarring of the ulcer defect in this group.