Determination of the main factors in the development of erosive and ulcerative lesions of the stomach in liver cirrhosis

Abstract

The leading factor of erosive and ulcerative lesions in the stomach, which are usually complicated by gastric bleeding (GB) is an acid-peptic factor that has a direct effect on varicose veins of the stomach, causing their erosion [1]. At the same time at portal hypertension (PH) subepithelial capillaries which are easily damaged even without considerable trauma sharply expand [2]. In addition, cirrhosis of the liver significantly increases the permeability to the blood of digestive and bacterial antigens with the formation of immune complexes, which is associated with a violation of the barrier function of the mucous membrane of the stomach and intestines. Settling in the submucosal layer and gastric mucosa, these complexes potentiate both the inflammatory process and gastric lesions (GL) in the form of acute ulcers and erosions [3]. Quite typical for PH is the occurrence of portal gastropathy (PGP), which is manifested by single petechial hemorrhages (moderate PGP) and numerous hemorrhagic erosions (severe PGP). According to the literature, PGP was detected in 43.6% of patients, including severe PGP - in 24% of cases [4]. The purpose of the study was to study the factors of development of erosive and ulcerative gastric lesions in liver cirrhosis. Materials and methods of research. There were studied results of examination of 135 patients with hepatic form of PH (liver cirrhosis) who were hospitalized to the clinic of the Department of Surgery №2 of the Bogomolets National Medical University. GL during upper endoscopy were found in 66 patients (48.9%): in 22 patients 33.4%) – PGP, in 21 patients (31.8%) - gastric erosions, in 23 (34.8%) - gastric ulcers. Gastric mucus was obtained during upper endoscopy, followed by its homogenization and centrifugation for 30 min at a speed of 3000 revolutions per min. At the same time, a precipitate was obtained, which was a model of a native mucous gel. The rheological properties of gastric mucus (the limit of elasticity of the mucus gel, the viscosity of the mucus) were studied using a precision rotary viscometer Rheotest-2 (Germany). Two indicators of mucus viscosity were determined: the initial viscosity of intact mucus (ƞ1) and the viscosity of mucus after destruction of its gel structure (ƞ2) [5]. In order to compare the rheological changes of gastric mucus, all studied patients with GL (66 people) were combined into the main group. The comparison group consisted of 50 healthy individuals. Results of the research. Patients with gastric ulcer are characterized by the most pronounced violations of the rheological properties of gastric mucus. In them the elastic limit of the mucous gel was twice lower than in healthy individuals, and the initial viscosity of intact mucus was 2.5 times lower and the viscosity of mucus after the destruction of its gel structure was 2.2 times lower. In patients with gastric erosions, the elastic limit of the mucous gel was 1.7 times lower than normal, and the initial viscosity of intact mucus was 2.2 times lower and the viscosity of mucus after destruction of its gel structure was 2 times lower, and in patients with PGP 1.5, 2 and 1.8 times respectively. Thus, the rheological properties of gastric mucus were reduced in 19 patients (90.5%) with gastric ulcers, 20 (87%) - gastric erosions and 18 (81.8%) - with PGP. Conclusion. In the development of erosive and ulcerative gastric lesions in liver cirrhosis the leading factor is not the actual hypertension, but increased transcapillary filtration in the edematous-ascitic stage of liver cirrhosis which due to portal stagnation and reduced colloid-osmotic properties of blood causes a decrease in protective properties of mucosal bicarbonate barrier causes the development of destructive lesions of the actual gastric localization. References: 1. Tandon P, Bishay K, Fisher S, Yelle D, Carrigan I, Wooller K, Kelly E. Comparison of clinical outcomes between variceal and non-variceal gastrointestinal bleeding in patients with cirrhosis. J Gastroenterol Hepatol. 2018 Oct;33(10):1773-1779. doi: 10.1111/jgh.14147. Epub 2018 May 4. PMID: 29601652. 2. Kumar R, Mills AM. Gastrointestinal bleeding. Emerg Med Clin North Am. 2011 May;29(2):239-52, viii. doi: 10.1016/j.emc.2011.01.003. PMID: 21515178. 3. Wilkins T, Wheeler B, Carpenter M. 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