In the structure of all anemias, iron deficiency anemias constitute approximately 80.0%. According to information provided by the Center for Medical Statistics of the Ministry of Health of Ukraine, the prevalence of anemia is 1.0% in the structure of morbidity. In Zakarpattia, the prevalence of anemia has varied from 980 to 1245 per 100,000 adults in different years. One of the main causes of iron deficiency anemias is gastrointestinal bleeding caused by peptic ulcer disease, erosive gastritis, hiatal hernias, stomach and intestinal tumors, and nonspecific ulcerative colitis. In addition to classical risk factors for iron deficiency anemias, there are also non-classical factors, including climatic and geographic factors such as altitude above sea level.
The dissertation is devoted to solving an extremely urgent scientific task - improving the effectiveness of treatment for patients with lymphoproliferative diseases with iron deficiency anemia affecting the esophagogastroduodenal zone, who reside in different altitude conditions, by studying the relationships between the clinical course, dynamics of hemoglobin levels, erythrocytes, serum iron, and ferritin.
To achieve the set goal, the study included 80 patients with multiple myeloma and diffuse large B-cell lymphoma affecting the esophagogastric-duodenal zone, who resided in mountainous and lowland areas of Zakarpattia and underwent chemotherapy courses according to the primary disease. The research objectives were based on a systemic approach, being comprehensive and adequate to the work's goals. The scope of the conducted study ensured obtaining reliable results: the presence of concomitant pathology in the form of lesions of the esophagogastric-duodenal zone in patients with iron deficiency anemia expands and complicates clinical manifestations in patients with lymphoproliferative diseases. It has been clarified that the peculiarities of the clinical course of iron deficiency anemia in patients with lymphoproliferative diseases affected in the esophagogastric-duodenal zone are determined by adaptation to hypoxia depending on the locality of residence of Zakarpattia residents. Lesions of the esophagogastric-duodenal zone in patients with multiple myeloma and diffuse large B-cell lymphoma residing in lowland areas of Zakarpattia are clinically more likely to manifest symptoms of GERD (in 90.0% of patients), gastritis (in 57.5% of patients), and peptic ulcer disease (in 26.3% of those examined).
In this case, the severity of clinical symptoms of EGDS lesions directly depends on H.pylori infection, which occurs in 70.0% of patients (p<0.05) with no significant difference among residents of different altitudes. In patients with lymphoproliferative diseases affecting the esophagogastric-duodenal zone, iron deficiency anemia manifests with more pronounced symptoms of anemic hypoxia, signs of sideropenic syndrome, and metabolic intoxication. Thus, endoscopic lesions of the mucous membrane of the esophagogastric-duodenal zone correspond to GERD and chronic Helicobacter-associated gastritis with varying degrees of erosive-ulcerative lesions, more frequently observed among patients residing in lowland areas compared to those from high-altitude regions (70.0% versus 50.0%). Additionally, there is a direct correlation between H.pylori infection and the severity of anemic hypoxia (r=0.90; p<0.01) and sideropenic syndrome (r=0.80; p<0.01).
It has been established that the proposed comprehensive therapy, including iron supplements, rebamipide, and anti-Helicobacter therapy for three weeks, positively affects the dynamics of clinical manifestations of iron deficiency anemia and normalizes the levels of hemoglobin, erythrocytes, iron, and ferritin in patients with both multiple myeloma and diffuse large B-cell lymphoma affecting the esophagogastric-duodenal zone. However, in patients residing in mountainous regions, the levels of hemoglobin, erythrocytes, iron, and ferritin after treatment are significantly higher than in residents of lowland areas (p<0.001), leading to a more rapid and significant reduction (p<0.05) in the manifestations of anemic hypoxia and sideropenic syndrome.
The results of our study convincingly demonstrate that the combination of basic treatment for iron deficiency anemia with anti-Helicobacter therapy alongside cytostatic therapy optimizes the management plan for patients with comorbid pathologies and improves the prognosis of disease progression.
