ACUTE GASTRODUODENAL EROSIONS IN PATIENTS WITH CORONARY ARTERY DISEASE AND CHRONIC HEART FAILURE: CLINICAL AND ENDOSCOPIC FEATURES AND THE ROLE OF MICROCIRCULATORY AND GASTRIC SECRETION DISORDERS IN THEIR DEVELOPMENT

The study included 94 patients with CAD with CHF, which were divided into four groups, depending on the severity of CHF and the presence of acute erosions. The state of the gastroduodenal zone and terminal blood flow in its mucosa, the changes of gastric secretion were evaluated with methods, adapted to the severity of the patients’ condition and the peculiarities of the cardiac pathology. It was found that usually acute erosions in CHF I-IIa stage represented a few, small defects of tissues with localization in the body and (or) antral part of the stomach. Erosions in patients with CHF IIb-III stage were multiple, small or medium in size and occupied significant areas of the mucosa of the body and the antrum of the stomach and the bulb of the duodenum. Clinical presentation of acute erosions in CHF I-IIa stage was determined as unstable unsharply expressed epigastric pain and signs of gastric dyspepsia. In CHF IIb-III stage, stable dyspepsia dominated, while the symptoms of a mild pain syndrome receded into the background. The development of acute erosions in CHF was promoted by thrombohemorrhagic microcirculatory disorders in the gastroduodenal mucosa, the severity of which increased jointly to the severity of CHF. These changes were accompanied by abnormalities of gastric secretion, which were manifested by activation of the acid-peptic factor in combination with moderate suppression of the protective mucus components production in CHF I-IIa stage, and by increased pepsinogen and inhibition of protective mucus production, normal acid secretion - in CHF IIb-III stage. Acute gastroduodenal erosions in patients with CAD with CHF have a number of clinical, endoscopic and pathogenetic features, which are determined mainly by the severity of CHF.

acute gastroduodenal erosions, chronic heart failure, clinical and endoscopic features, changes of gastric secretion, local microcirculatory disorders

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