O. Yatskevych, O. Abrahamovych, I. Korniichuk

Danylo Halytsky Lviv National Medical University

Introduction. The victims of the Chernobyl accident have a significantly higher morbidity compared to the unaffected population. Ulcerative lesions of the gastric and duodenal mucosa are quite common.

The aim of the study. To find out some features of ulcerative lesions of the gastroduodenal zone in the victims of the Chernobyl accident based on the analysis of the causes, pathogenesis, clinical signs, conducted in the third of the century after the disaster.

Materials and methods. The study involved 115 patients with ulcerative lesions of the gastroduodenal zone. The experimental group (EG) of 80 patients who suffered as a result of the Chernobyl accident and the comparison group (GC) of 35 patients who were not affected by the Chernobyl disaster. The control group (CG) consisted of 30 conditionally healthy volunteers.

Results. In patients affected by the Chernobyl accident, heredity plays a significantly smaller role than in patients with GC (28.7 % patients of EG against 48.6 % of GC, p < 0.05). Smoking and use of nonsteroidal anti-inflammatory drugs were significantly more relevant in those affected by the Chernobyl disaster (75.0 % of patients with EG and 31.4 % of GC; p < 0.05). All patients EG were exposed to higher radiation (100.0 % EG and 0.0 % GC). The cytoprotection of the gastroduodenal zone in patients EG with gastric ulcer in both gastric juice and insoluble mucus were significantly lower compared with GC (EG: NANA of gastric juice 0.27 ± 0.01 vs. 0.58 ± 0.02 mg/ml; p < 0.05; GC: NANA in insoluble mucus 0.45 ± 0.04 vs. 1.16 ± 0.09 mg/ml; p < 0.05). The cytoprotection of the gastroduodenal zone in patients EG with duodenum ulcer in both gastric juice and insoluble mucus were significantly lower compared with GC (EG: NANA in gastric juice 0.29 ± 0.02 vs. 0.53 ± 0.03 mg/ml; p < 0.05; GC: NANA in insoluble mucus 0.44 ± 0.07 vs. 1.09 ± 0.08 mg/ml; p < 0.05). Significant increase in heart rate and decrease in amplitude of heart rhythm oscillations and consequently HRV parameters were observed in patients EG compared to GC in both supine position and orthostatic test. In most patients, who are victims of the Chernobyl accident, a specific pattern of HRV (decrease of heart rhythm oscillations (decrease in SDNN and TP), relatively high level of VLF waves, moderate decrease in LF and dramatic decrease in HF) was observed. All patients were divided into three groups, depending on parameters of lipid peroxidation and activity of AOS (AAOS). Group number 1 (with enhanced LPO), group number 2 (with normal LPO) and group number 3 (with reduced LPO). All groups were divided into subgroups according to the AAOS: AAOS increased (subgroup 0.1.) normal activity AOS (subgroup 0.2.) and reduced AAOS (subgroup 0.3.). Some patterns were found after comparison. The results were different vectors. Number of patients with increased LPO (group 1) was significantly different (96.2 %* of patients EG and 68.6 % of patients GC (* p < 0.05). Indicators of patients with reduced lipid peroxidation show that the lowest incidence of such cases were among patients EG (3.7 %*), while in GC in 14.3% of patients (*p < 0.01). During endoscopic examination, we found that ulcers from 1.1 to 2.0 cm, there were more EG patients (60.0 % EG and 31.4 % GC; p < 0.05), so they also had significantly more concomitant erosive lesions of the mucous membrane of the stomach (50.0 % EG and 20.0 % GC; p < 0.05) and duodenum (47.5 % EG and 17.1 % GC; p < 0.05). Patients victims of the Chernobyl accident were significantly more often detected reflux conditions including reflux esophagitis (78.8 % EG and 42.9 % GC; p < 0.05), duodenal-gastric reflux (68.8 % EG and 34.3 % GC; p < 0.05). Patients EG significantly more often encountered diffuse chronic gastritis with atrophic changes in the gastric mucosa (57.5 % of the patients in the EG and 28.6 % of the GC; p < 0.05). The patients (affected by the Chernobyl accident) have multiple complaints with its own characteristics. They were significantly less concerned about the intense pain in gastroduodenal zone (intense abdominal pain in 22.5 % of patients EG and 60.0 % of the patients GC, p < 0.05; painless ulcer in 30.0 % of patients EG and in 8.6 % patients GC; p < 0.05). Symptoms of gastric and intestinal dyspepsia, the asthenic-neurotic syndrome are much more often.

Conclusions. Ulcerative lesions of the mucosa of gastroduodenal in victims of the Chernobyl accident in the long term after the disaster, according to the analysis of the causes, pathogenesis, clinical signs have certain features, compared with patients who did not suffer from the Chernobyl disaster. All victims of the Chernobyl accident were exposed to ionizing radiation. Smoking and use of ulcerogenic drugs, stress and dietary disorders are significantly more frequent in victims of the Chernobyl accident, but aggravated heredity is less common. In the pathogenesis of important place is occupied by changes in the ratio of peptic-aggressive and cytoprotective factors of gastric contents in the direction of reducing the protection of the mucous membrane of the gastroduodenal zone; in patients, who are victims of the Chernobyl accident, compared with patients control, there is a decrease in heart rate variability, as well as a more pronounced internal redistribution of parameters with a relative predominance of central and humoral-metabolic effects on heart rate and a decrease in the amplitude of waves arising from parasympathetic activity; also revealed multi-vector (increased, within normal limits, decreased) state of lipid peroxidation and activity of the antioxidant system (the number of the Chernobyl patients with enhanced lipid peroxidation and reduced activity of the antioxidant system is relatively greater). The morphological forms of gastric and duodenal lesions are dominated by pangastritis with atrophic changes of the mucous membrane, the presence of ulcerative defects of medium and large size, as well as more frequent reflux esophagitis, duodeno-gastric reflux and concomitant erosive lesions. Features of clinical manifestations are the dominance of astheno-neurotic and dyspeptic syndromes, minimization or absence of typical pain.

References

1. Abrahamovych OO, Cherkas AP. The peculiarities of aerobic metabolism and heart rate variability in patients with duodenal peptic ulcer, combined with neurocirculatory dystonia, and their changes under the influence of amaranth oil. Ukrainian Therapeutical Journal. 2012;2(34):39-46. (Ukrainian)
2. Abrahamovych OO, Cherkas AP, Semen KO, Yatskevych OYa, Yelisyeyeva OP. The efficiency assessment study of amaranth oil supplementation in the complex treatment of duodenal peptic ulcer (based on the clinical, instrumental investigations and heart rate variability). Contemporary Gastroenterology. 2009; 6(50):54-61. (Ukrainian)
3. Bebeshko VG, Kovalenko AN, Buzunov VA et al. Health Effects of the Chernobyl disaster in Ukraine. Journal of the Academy of Medical Sciences of Ukraine. 2006;12(1):21-31. (Ukrainian)
4. Gaydayev YuO, editor. The state of health of the victim population of Ukraine, 20 years after the Chernobyl disaster: The statistical and analytical information in the two parts. Kyiv: NDVP “Tehmedekol” Publisher; 2007. (Ukrainian)
5. Gasanova EV. Dynamics of the incidence of peptic ulcer of the stomach and duodenum in participants of the liquidation of the consequences of the CNPP accident (according to the results of long-term observation). Likars’ka Sprava. [Medical Practice] 2004;7:14-17. (Russian)
6. Twenty five years after the Chernobyl disaster. Security of the Future. National Report of Ukraine. Kyiv: KIM; 2011. (Ukrainian)
7. INES Guide for users of the International Nuclear and Radiological Event Scale [Electronic resource]. Access mode: https:// www-pub.iaea.org/MTCD/publications/PDF/INES-2008-R_web.pdf (Russian)
8. Kimakovych VJ, Nikishaev VI, Tumak IM et al. Endoscopy of the digestive tract. Norm, pathology, modern classifications. Lviv: World Medicine Publishing House; 2008. (Ukrainian)
9. Kovalenko AN, Gasanova EV. Role of the hypothalamic-pituitary-adrenocortical system functional state abnormalities in the development inflammatory and erosive-ulcerative lesions among the Chernobyl NPP accident liquidators. Ukrainian Medical Journal. 2005;5(49):115-120. (Russian)
10. International Nuclear Event Scale [Electronic resource]. Access mode: https://uk.wikipedia.org/wiki/International_scale_of_nuclear_events (Ukrainian)
11. Order of the Ministry of Health of Ukraine of 28.09.2012 N 751 On the creation and implementation of medical and technological documents for standardization of medical care in the system of the Ministry of Health of Ukraine, with annexes N 1422 from 29.12.2016, N 1752 from 26.09.2018 [Electronic resource]. Access mode: https://zakon.rada.gov.ua/laws/show/z2001-12#Text. (Ukrainian)
12. Perederiy VG, Tkach SM, Skopichenko SV. Peptic ulcer disease. The past. The present. The future. In the world and in Ukraine. Kyiv: Blitz-Inform; 2003. (Russian)
13. On approval of standards for medical care and quality indicators of medical care. Order of the Ministry of Health of Ukraine dated 28.12.2002 N 507 [Electronic resource]. Access mode: http://www.moz.gov.ua/ua/portal/dn_20021228_507.html. (Ukrainian)
14. Tkachishin VS. Gastro-intestinal diseases dynamics among liquidators who took part in Chernobyl postaccidental work. Ukrainian Medical Journal. 2000;6(20):118-120. (Ukrainian)
15. Cherkas AP, Semen KO, Yelisyeyeva OP et al. The peculiarities of heart rate variability and gastric mucosa histological structure depending of Helicobacter pylori contamination in patients with duodenal peptic ulcer and healthy volunteers. Contemporary Gastroenterology. 2006;4(30):44-49. (Ukrainian)
16. Cherkas A, Eckl P, Gueraud F, Abrahamovych O, Serhiyenko V, Yatskevych O et al. Helicobacter pylori in sedentary men is linked to higher heart rate, sympathetic activity, and insulin resistance but not inflammation or oxidative stress. Croat Med J. 2016;57:141-149.
17. Cherkas A, Golota S, Guéraud F, Abrahamovych O, Pichler C, Nersesyan A et al. A Helicobacter pylori-associated insulin resistance in asymptomatic sedentary young men does not correlate with inflammatory markers and urine levels of 8-iso-PGF(2)-α or 1,4-dihydroxynonane mercapturic acid. Arch Physiol Biochem. 2018;124(3):275-285.
18. Cherkas A, Yatskevych O. The amplitude of heart rate oscillations is dependent on metabolic status of sinoatrial node cells. OA Med Hypothesis. 2014;2:1-8.
19. Connes P, Hue O, Hardy-Dessources MD et al. Hemorheology and heart rate variability: is there a relationship? Clin Hemorheol Microcirc. 2008;38(4):257-265.
20. Heart Rate Variability Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation. 1996;93:1043-1065.