The Kazakh National medical university named after S.D.Asfendiyarov, Almaty
Helicobacter pylori (Hp) infection is the main cause of different gastroduodenal diseases. Alcohol is known to influence negatively on the gastro-intestinal tract.The investigations show that secretion of HCl and pepsin lowers and atrophy degree of gastric mucous membrane increases in alcoholics.
Objective of the investigation:-to study the impact of Helicobacter pylori & systematic drinking alcohol on the morphological deviations of gastric mucous membrane in patients with different forms of alcohol hepatic disease.
Material and methods 239 patients with different forms of alcohol hepatic disease admitted to the clinics of Almaty were under our observation. Males accounted 84,9% of the examined patients that is 203 of 239 examined ones. The number of females was 36 (15,1%). In all the examined patients there was carried out the analysis of clinical data (anamnesis, subjective signs of the disease), indices of functional hepatic tests,results of abdomen organs USI, oesophagogastroduodenoscopy, determinig Hp infection in gastric mucous membrane by urease method."Alcoholic" character of the disease was revealed with the help of GAGE questionnaire and a specially developed questionnaire including data about age, social-economic status, duration, multipleness, number of the drinking alcohol examination with finding out "alcoholic stigms" (palmar erythema, contracture of Dupuitren, lowering intellect, capillary network on a face), changes of laboratory indices (enlarging corpuscular volume of erythrocytes, increasing activity of gammaglutamintranspeptidase).Persons drinking alcohol daily accounted 37,5 %. We found out that the main mass of the examined persons systematically drunk alcohol (from 4 to 7 times a week) for a long period of time (in the average 12,7± 3,1 years).Results of the complex examination of 239 patients drinking alcohol for a long time enabled to diagnose different forms of alcoholic hepatic disease Analysis of the obtained data showed that 128 (53,6 %)-patients of 128 ones drinking alcohol for a long time had alcoholic steatohepatitis (ASH) as the most frequent form of liver affection. Alcoholic hepatic cirrhosis (AHC) as the next form of AHD took the second place and it was diagnosed in 70 (29,3%)patients.Only 41 (17,1 %) patients with "alcoholic anamnesis" have alcoholic hepatic steatosis (AHS).
On endoscopic examination all the patients with AHD had different deviations of gastroduodenal zone mucous membrane and different rate of Hp infection finding in gastrobioptates. The summarized data about the rate of Hp infection revealing in groups of patients with different forms of AHD are presented in table . In the group of patients with AHS there were 18 (43,9%) Hp-positive patients, 23(56,1 %)Hp-negative ones.Hp infection was founded in the group of 102 patients with AHS(92,9 %).The most number of Hp-positive cases occured in the group of patients with AHC (92,9 %).Hp-negative cases occured in the group of patients with AHS most frequently (56,1%) and least of all in the group of ones with AHC (7,1 %).
Rate of Hp-positive (+) & Hp-negative (-)patients with AHD
N Hp infection AHS (n=41) ASH (n=128) AHC (n=70) Total(n=239)
abs % abs % abs % abs %
1. Hp-positive 18 43,9 102 79,7 65 92,9 185 77,4
2. Hp-negative 23 56,1 26 20,3 5 7,1 54 22,6
3. Total 41 100,0 128 100,0 70 100,0 239 100,0
Summarizing the obtained data it should be noted that among the examined patients with AHD there were 185 (77,4 %) Hp-positive persons, 54 (22,6%)Hp-negative ones. The results of endoscopy testify that among Hp-negative patients with AHD there was the high rate of gastroduodenal pathology (22,6%),that exeeds the mean population data, given in the literature. In this connection taking into account the results of complex examinations of patients with verification of alcoholic origin in hepatic pathology and revealing Hp-associative gastroduodenal pathology in them two aggressive factors as virulent properties of both Hp infection and alcohol should be considered to be synergic impact on GMM.
The data obtained during the investigation predetermine the necessity of the further studying the given problem and developing algorithm of therapeutic-preventive measures for patients with AHD, having gastroduodenal pathology.
Жанкалова З.М. Синергическое воздействие Helicobacter Pylori и алкоголя на слизистую оболочку желудка. // Современные проблемы науки и образования - 2009.-№6. (приложение "Медицинские науки"). - C. 25