Ulcerative Lesions of the Mucosa Gastro-Duodenal Zone in Victims of the Chernobyl Accident: Some Features of the Etiology, Pathogenesis and Clinical Signs Identified in the Third of the Century After the Disaster
Authors:   Danylo Halytsky Lviv National Medical University, Yatskevych O. , Abrahamovych O. ,   Danylo Halytsky Lviv National Medical University, Korniichuk I. ,   Danylo Halytsky Lviv National Medical University
Published: October 2020

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 less than 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 less than 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 less than 0.05; GC: NANA in insoluble mucus 0.45 ± 0.04 vs. 1.16 ± 0.09 mg/ml; p less than 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 less than 0.05; GC: NANA in insoluble mucus 0.44 ± 0.07 vs. 1.09 ± 0.08 mg/ml; p less than 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 less than 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 less than 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 less than 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 less than 0.05) and duodenum (47.5 % EG and 17.1 % GC; p less than 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 less than 0.05), duodenal-gastric reflux (68.8 % EG and 34.3 % GC; p less than 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 less than 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 less than 0.05; painless ulcer in 30.0 % of patients EG and in 8.6 % patients GC; p less than 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.