Journal of Human and Animal Intestines

Current Issue Volume No: 1 Issue No: 1

ISSN: Coming Soon
share this page

In Brief Open Access
  • Available online freely Peer Reviewed
  • Clinical Gastroenterological Manifestations as Criteria for the Pathology and Effectiveness of Surgical Correction of Reflux Disease of the Digestive System

    Martynov Vladimir Leonidovich 1  

    1Doctor of Medical Sciences, Associate Professor, National Research Nizhny Novgorod State University named after N.I. Lobachevsky (UNN), Russia

    Abstract

    The presence of numerous complaints of a gastroenterocolitic nature in patients with proven NBZ and CNDP and a sharp regression of these complaints after surgical correction of NBZ and CNDP allows us to conclude that the causes of these pathological manifestations are the failure of the Bauhinia valve and chronic violation of the duodenal patency, and the most adequate surgical aid for elimination of clinical manifestations of reflux disease is bauginoplasty with simultaneous duodenojejunostomy.

    Author Contributions
    Received 04 Jan 2021; Accepted 22 Jan 2021; Published 27 Jan 2021;

    Academic Editor: Mohamed Mostafa El-Sayed Abdulla, Consultant in pharmaceutical industries, Egypt.

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright ©  2021 Martynov Vladimir Leonidovich

    License
    Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Martynov Vladimir Leonidovich (2021) Clinical Gastroenterological Manifestations as Criteria for the Pathology and Effectiveness of Surgical Correction of Reflux Disease of the Digestive System. Journal of Human and Animal Intestines - 1(1):15-19.

    Download as RIS, BibTeX, Text (Include abstract )

    DOI Coming Soon

    Introduction

    Cases of failure of the Bauhinia flap (NBZ), the presence of chronic impairment of duodenal patency, reflux gastritis, gastroesophageal reflux disease (GERD) have been known for a long time. However, until now, practical medicine does not have specific data - is it possible the presence of several pathological conditions on the basis of reflux of the contents of the underlying departments into the overlying ones in one patient. The clinical possibilities of simultaneous correction of reflux - enteritis, reflux - gastritis and reflux - esophagitis are also unknown. the general etiopathogenetic links of these conditions are not known. The causal relationship between the gastrointestinal tract (GIT) and some extraintestinal diseases, in particular bronchial asthma and dermatoses, has not been studied. Basically, numerous complaints of a gastroenterocolitic nature are explained by functional changes in the gastrointestinal tract, in particular, the functional form of chronic duodenal obstruction (CDP) and irritable bowel syndrome (IRS). At the same time, both patients and doctors of various specialties are doomed to a long dialogue, since recovery does not occur. According to our data, in most patients with these complaints, 94% of patients have proven NBZ and the anatomical form of CNDP, which is also diagnosed in patients with duodenal ulcer (PU 12 - PC), gastric ulcer (PU), bronchial asthma (BA ), dermatoses 1, 2, 3, 4, 5. Therefore, we concluded that the concept of reflux disease should be understood as the simultaneous presence of the following refluxes in patients: colonic, duodenogastric (DGR), gastroesophageal (GER), which implies their simultaneous correction at all levels 1, 2, 3, 4, 5.

    Complaints from Patients with Reflux Disease.

    All patients with reflux disease (RB) complained of abdominal pain, of which 57% of the pain were diffuse, in 7% of patients the pain was localized in the right iliac region, in 3% in the right hypochondrium, in 2% in the left iliac region, in 4% - in the left and right iliac regions, in 9% - in the right iliac and right hypochondrium regions, in 16% - in the right and left hypochondrium regions, in 2% - in the left hypochondrium and left iliac regions.

    In addition to abdominal pain, patients with RB were worried about other complaints typical of gastrointestinal pathology: - 95% of patients noted rumbling in the abdomen, - 79% - bloating, - 71% - constipation, - 65% - diarrhea, - 86% - loosening of the chair, - 88% - feeling of heaviness in the abdomen after eating, - 83% - nausea, - 87% - belching with air, - 95% - bitterness in the mouth, - 79% - bad breath, - 55% - intolerance to milk and other food.

    Rapid fatigue occurred in 92% of patients, and in 58% weight loss. In addition to complaints of a gastroenterocolitic nature, 65% of patients noted increased heart rate, 72% - dizziness, 66% - frequent colds (acute respiratory infections, flu, tonsillitis).

    Analyzing the clinical manifestations of gastroenterocolitic nature in patients suffering from PUD, PU 12 PK, BA, dermatoses, we can conclude that these complaints are also found in the overwhelming majority of these groups of patients (Table 1).

    Table 1. The clinical picture in patients with NBZ and HNDP, YABZh and 12 PCs, BA, dermatoses (in%)
    Clinical manifestations RB (NBZ, KhNDP) N = 318 YABZH and YAB 12 PC N = 149 BA N = 228 Der-mato-zy N = 54
    Abdominal pain 100 100 63 78
    Abdominal heaviness after eating 79 69 81 51
    Belching with air 80 73 61 53
    Spitting up food 52 32 45 12
    Heartburn in the epigastrium 68 80 74 56
    Heartburn behind the breastbone 68 10 74 56
    Bitterness in the mouth 73 18 74 15
    Nausea 79 73 49 34
    Constipation 73 56 47 56
    Diarrhea 51 21 43 49
    Loose stools 65 27 43 49
    Intolerance to milk and other food 44 17 41 44
    Fatigue 92 95 92 63
    Weight loss 54 46 43 19
    Bad breath 75 77 52 17
    Bloating 78 80 62 41
    Rumbling in the stomach 86 80 62 71
    Heartbeat 65 27 77 68
    Dizziness 72 16 66 71
    Darkening in the eyes 66 14 70 58

    Thus, patients with NBZ and CNDP, as well as patients with gastric ulcer and duodenal ulcer, bronchial asthma, dermatoses present numerous complaints of the same type of gastroenterocolitic nature, which suggests that this group of patients has a single etiopathogenesis of these pathological manifestations. This category of patients underwent different volumes of operations: bauginoplasty (BP), bauginoplasty in combination with dissection of Treitz's ligament (BP + PCT), bauginoplasty in combination with duodenojejunostya (BP + DES) - Table 2.

    Table 2. Clinical picture in patients before and after surgical correction of RB
    Symptoms NBZ, KhNDP (RB) N = 415 After bauginoplasty N = 68 After bauginoplasty + PCT N = 24 After bauginoplasty + duodenojejunostomy N = 19
    Stomach pain 415 (one hundred%) 24 (34%) р < 0.0001 8 (35%)p < 0.0001 5 (27%)р < 0,0001
    Heaviness in the abdomen after eating 327 (79%) 18 (26%)р < 0,0001 6 (25%)р = 0,0006 2 (12%)р < 0,0001
    Nausea 327 (79%)  12 (18%)р < 0,0001 5 (21%)р = 0,0002 2 (12%)р < 0,0001
    Burp 322 (80%)  24 (35%)р < 0,0001 9 (38%)р = 0,0038 2 (12%)р < 0,0001
    Regurgitation 216 (52%) 9 (13%)р < 0,0001 5 (21%)р = 0,0178 1 (5%)р = 0,0015
    Heartburn 282 (68%) 26 (38%)р = 0,0001 12 (50%)р = 0,1901 2 (12%) р = 0,0003
    Bitterness in the mouth 303 (64%) 29 (43%)р = 0,001 10 (40%)р = 0,0196 2 (12%)р = 0,0001
    Constipation 303 (64%) 11 (16%)р < 0,0001 4 (16%)р = 0,0001 2 (12%)р = 0,0001
    Diarrhea 212 (51%) 14 (21%)р = 0,0002 3 (13%)р = 0,0057 2 (12%)р = 0,0064
    Relaxation 270 (65%) 17 (25%)р < 0,0001 4 (16%)р = 0,0005 2 (12%)р = 0,0009
    Intolerance to milk and other food 183 (44%)  10 (18%)р = 0,0001 3 (14%)р = 0,0122 4 (24%)р = 0,1476
    Fatigue 324 (93%)  15 (22%)р = 0,0004 7 (29%)р =0,0196 3 (18%)р <0,0001
    Weight loss 224 (54%)  13 (19%)р < 0,0001 4 (17%)р < 0,0073 1 (6%)р < 0,0015
    Weight loss 317 (75%) 10 (14%)р < 0,0001 3 (14%)р < 0,0001 2 (12%)р < 0,0001
    Bad breath 324 (78%)  5 (7%)р < 0,0001 3 (14%)р < 0,0001 2 (12%)р < 0,0001
    Bloating 357 (86%)  10 (15%)р < 0,0001 5 (21%)р < 0,0001 2 (12%)р < 0,0001

    Analyzing the clinical manifestations before and after surgery, one can note a sharp regression of gastroenterocolitic complaints (Table 2). The identified set of complaints depends on the condition of the small and large intestine. Improvement of the condition of patients after PD, PD + PCT, PD + DES confirms the main role of PD in the elimination of this symptom complex. The number of patients who stopped noticing these pathological manifestations increased from 2 to 11 times, depending on various symptoms.

    Nevertheless, in a significant number of cases, clinical signs of CNDP remain in patients who underwent only bauginoplasty or bauginoplasty with PCT. So, after such volumes of surgical aid, the severity in the abdomen remained in 26% and 25% of patients, respectively, for the indicated operations, nausea - in 18% and 21%, belching - in 35% and 38%, regurgitation - in 13% and 21%, heartburn - 38% and 50%. Surgical aid in the form of bauginoplasty and duodenojejunostomy turned out to be much more adequate in eliminating the clinical manifestations of CPDP. So, the heaviness in the abdomen after eating remained only in 12% of patients, nausea - in 12%, belching - in 12%, regurgitation - in 5%, heartburn - in 12%.

    Thus, the presence of numerous gastroenterocolitic complaints in patients with proven NBZ and CNDP and a sharp regression of these complaints after surgical correction of NBZ and CNDP allows us to conclude that the causes of these pathological manifestations are the failure of the Bauginia valve and chronic violation of duodenal patency, and the most adequate bauginoplasty with simultaneous duodenojejunostomy is a surgical tool for eliminating clinical manifestations of reflux disease.

    References

    1.Martynov V. (2014) Refluxes in gastroenterology. Causes, effects, surgical treatment, prospects. 505.
    2.Martynov V. (2016) SIBR: surgical treatment and prevention. Palmarium Academic Publishing. 207.
    3.Martynov V, Kolchin D, Kurilov V. (2018) Surgical prevention of reflux of the digestive system (results and scientific and practical prospects). Palmarium Academic Publishing. 334, p..
    4.V L Martynov. (2018) Delayed interintestinal anastomoses (new variants of formation). 159.
    5.V L Martynov. (2020) Prevention of the development of refluxes of the digestive system. Palmarium Academic Publishing. 130.