The purpose of the dissertation research was to clarify the pathogenetic significance
of somatoneurological relationships in duodenal ulcer and to improve diagnostic principles,
approaches to therapeutic practice in patients with nervous system damage in duodenal ulcer
based on the data of a comprehensive clinical, neurological, neuropsychological and
paraclinical study.
The work is based on the analysis of the results of the study of patients for the period
from 2018 to 2022 who were examined and treated at the Department of Gastroenterology
and the Centre for Gastrointestinal Bleeding at Kyiv City Clinical Hospital No. 12, which is
the clinical base of the Department of Neurology of P.L. Shupyk National University of
Health of Ukraine.
In accordance with the tasks set in this study, we conducted a comprehensive
examination of 84 patients with duodenal ulcer in the acute stage and 84 patients in the
remission stage of the disease. All the patients were divided into two groups based on the
presence of exacerbation (group 1) or remission of UC (group 2). We conducted a
comprehensive examination of 60 patients with duodenal ulcer in the acute stage, depending
on the presence of Helicobacter pylori in these patients. All subjects were divided into two
groups based on the presence of Helicobacter pylori (H.pylori) infection in patients with
duodenal ulcer (group 1) or its absence in patients with duodenal ulcer (group 2). The control
group consisted of 30 healthy individuals without somatic pathology.
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The clinical examination of patients was carried out according to a single generally
accepted examination scheme and included the collection and assessment of anamnesis,
objective examination, including an extended examination of the neurological status and
gastrointestinal condition. All patients underwent a comprehensive neuropsychological
examination (Stilberger-Hanin questionnaire for assessing reactive and personality anxiety,
Beck Depression Scale, assessment of cognitive function (MMSE), assessment of attention
span and performance dynamics using Schulte tables, SAN technique) and examination of
autonomic nervous system (questionnaires to determine the signs of autonomic changes by
Wayne's autonomic nervous system for the patient and for the doctor).
Clinical and laboratory tests included a complete blood count, determination of Creactive protein, total cholesterol, glucose, urea and creatinine levels in the blood,
calculation of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio
(PLR).
Instrumental methods of examination included electroencephalography, impedance
plethysmography (IP) and X-ray of the thoracic spine. All patients with IBD underwent
esophagogastroduodenoscopy with rapid diagnosis of H. pylori in the endoscopy room
(rapid urease test).
The data were calculated using a personal computer and the software package for
processing and analysing statistical information "STATISTICA 6.0".
After analysing the survey data, characteristics of the neurological status and
manifestations of autonomic dysfunction in patients with UC in the acute and remission
stages, we found that most psychosomatic complaints, neurological manifestations and
manifestations of autonomic dysfunction occurred both in the acute and remission stages of
the disease. All the identified clinical and neurological features were significantly more
common in the exacerbation stage of UC (p<0.05). It was established that patients with UC
PSC are characterised by manifestations of nervous system dysfunction, in particular
anxiety, depressive disorders, decreased well-being and cognitive impairment. Comparison
of the test results in the dynamics allowed us to conclude that in remission, the psychoemotional state of patients significantly improves (p<0.05).
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Complaints related to psycho-emotional disorders were found both in patients with
H. pylori positive and H. pylori negative gastric and duodenal ulcers, however, they were
more frequent in patients with H. pylori positive gastric and duodenal ulcers. Manifestations
of depression and anxiety were noted in both study groups, but the level of depression and
personal and reactive anxiety was significantly higher in the group of patients with H. pylori
positive gastric and duodenal ulcers compared to the group of patients with H. pylori
negative gastric and duodenal ulcers (p<0.05). In the group of patients with H. pylori
positive gastric and duodenal ulcers, lower self-assessment of functional status was
recorded. According to the study using Schulte tables, patients with H. pylori positive gastric
and duodenal ulcers showed a greater decrease in concentration than patients with H. pylori
negative gastric and duodenal ulcers.
