Yatskevych O. The peculiarities of pathogenesis, clinical and functional signs, and treatment of peptic gastro-duodenal ulcer accompanied by essential hypertension in subjects affected by Chernobyl nuclear power plant accident

The dissertation concerns the improvement of diagnostics and increase of the treatment efficiency of subjects affected by Chernobyl nuclear power plant accident (SAC) with comorbid gastro-duodenal peptic ulcer and hypertension. This is achieved by the clarifying the peculiarities of etiology, balance of peptic-aggressive and cytoprotective factors of stomach content, metabolic homeostasis and heart rate variability (HRV); endo- and microscopic state of mucous membrane of stomach and duodenum and clinical manifestations of comorbid diseases. It was established that the pathogenic influence of Helicobacter pylori infection was accompanied by the influence of ionizing radiation, acute and chronic stress, iatrogenic and drug load, bad habits, and diet derangements. The disturbances of the balance between aggressive and cytoprotective factors, multidirectional lipid peroxidation and antioxidant balance changes and significant strain of regulatory mechanisms with the prevalence of central, humoral and metabolic influences and the derangements of autonomic balance with relative dominance of sympathetic activity. The morphological forms of gastro-duodenal lesions determined by the endoscopic evaluation are pangastritis with atrophic changes of mucous membrane, predominantly in the antrum, large and medium-size ulcerative lesions, as well as higher prevalence of reflux-esophagitis, duodeno-gastral reflux, and related erosive damage of stomach and duodenum. The peculiarities of clinical manifestations include the dominance of astheno-neurotic and dyspeptic syndromes, minimization or the absence of typical pain syndrome, and the rarity of classical peptic ulcer progression. Obtained information provided improvement of diagnostics and further suggestion and justification of new principles of differentiated treatment, which appeared to be significantly more effective than traditional treatments.