CALCIUM IMBALANCE IN THE PATHOGENESIS OF SYMPTOMATIC GASTRODUODENAL ULCERS ASSOCIATED WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS, AND EFFECTIVENESS OF BLOCKERS OF SLOW CALCIUM CHANNELS IN THEIR TREATMENT

Abstract

84 patients with recurrent peptic ulcer disease and simtomatic gastroduodenal ulcers associated with nonsteroidal anti-inflammatory drugs (NSAIDs) were examined. The first group consisted of patients with relapse of UX, the second - patients with SRS. Groups did not differ in age, sex and localization of ulcers. Each included 7 men, with an average age of 49.4±3.6 years, and 7 women aged 51.2±2.2 years. 9 examined ulcers were located in the stomach, 5 - in the duodenum. All patients of these two groups, except for complex therapy, including diet, protective regime, cytoprotectors, anti-secretory agents, according to indications, preparations of eradication HP-therapy of the I line, received bmkk nifedipine 0.01 three times during the course of treatment (2-4 weeks). To clarify the effectiveness of the use of nifedipine in the treatment of relapse of gastric ulcer and duodenal ulcer and gastric ulcer and duodenal ulcer, a third group was formed, including 56 patients (42 men and 14 women) with relapse of gastric ulcer and duodenal ulcer (12 patients with ulcers of the stomach, 44 - duodenum), the average age of 33.9±11.7 years, who received similar therapy to the two main groups only without nifedipine. A study of blood calcium found that gastroduodenal ulcers are accompanied by a significant (p<0.05) increase compared to healthy individuals (2.04±0.05 mmol/l) in all groups. In the study of regional microcirculation in biopsies WITH periulcerous zone all patients with recurrent of gastric ulcer and duodenal ulcer and SGDU identified violations, characterized by congestion and enlargement of the capillaries and venules, arterioles spasm, microthrombuses, edema and hemorrhage in the perivascular tissue. However, SRS and a more significant increase in blood calcium levels were accompanied by more pronounced vascular and intravascular disorders, and relapse of gastric ulcer and duodenal ulcer - perivascular changes in the final blood flow. Comparing the presented data with the results of our studies presented in previous works, we can assume that the SRS as well as the recurrence of gastric ulcer and duodenal ulcer occurs against the background of dysfunction of the calcium regulating system with an increase in blood calcium levels, which contributes to the formation of such mechanisms of ulcerogenesis as violation of regional microcirculation, activation of the acid-peptic factor and the development of hypermotor dyskinesia of the stomach. Symptomatic gastroduodenal ulcers, as well as the recurrence of peptic ulcer disease, are accompanied by an increase in blood calcium levels, reflecting the dysfunction of the calcium regulating system and contributing to the formation of the main mechanisms of ulcerogenesis. The inclusion in the complex therapy of symptomatic gastroduodenal ulcers associated with NSAIDs and recurrence of peptic ulcer of slow calcium channel blockers is pathogenetically justified and clinically effective.