PECULIARITIES OF ACID PRODUCTION AND PATHOGENESIS OF PYLORIC AND PREPYLORIC GASTRIC ULCER COMPLICATIONS

Area of Science:

• Gastroenterology
• Pathophysiology
• Internal Medicine

Background:

• Peptic ulcers, including duodenal and type III (pyloric/prepyloric) ulcers, present varied clinical courses.
• Understanding the pathogenesis of different ulcer types is crucial for effective treatment strategies.
• Resistance to conservative therapy and complicated courses are significant challenges in managing certain peptic ulcers.

Purpose of the Study:

• To identify pathogenesis features of prepyloric and pyloric ulcers.
• To determine the cause of resistance to conservative therapy in type III ulcers.
• To understand the tendency towards complicated courses in type III ulcers (H.D. Johnson classification).

Main Methods:

• Comparative analysis of acid production in 150 patients (80 with duodenal ulcer, 70 with type III ulcer).
• Assessment of daily intragastric acidity patterns.
• Exploration of digestive juice secretion peculiarities based on ulcer localization.
• Morphological examination of the antrum muscle layer in pyloric and prepyloric ulcers.

Main Results:

• Patients with duodenal ulcers exhibit an individual daily intragastric acidity rhythm with nocturnal peaks.
• Specific morphological changes in the antrum muscle layer are characteristic of pyloric and prepyloric ulcers.
• These changes include myocyte vacuolation, edema, plexus hypertrophy, hemorrhages, and disrupted muscle bundles, leading to motor-evacuation disorders and duodenogastric reflux.

Conclusions:

• Antisecretory drugs are pathogenetically valid for duodenal ulcer treatment.
• Therapeutic algorithms for pyloric and prepyloric ulcers require improvement due to identified pathogenetic factors.
• Morphological changes in the pyloric/prepyloric ulcer muscle layer contribute to treatment resistance and complications.