actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2019-4.5.3actabiomedica-2163Research ArticleВНУТРЕННИЕ БОЛЕЗНИINTERNAL DISEASESСравнение эндоскопической картины при осложнениях со стороны верхних отделов желудочно-кишечного тракта, вызванных приёмом антитромботических средств и нестероидных противовоспалительных препаратовComparison of the Endoscopic Picture in Case of Complications of the upper Gastrointestinal Tract Caused by the Use of Antithrombotic Agents and Non-Steroidal Anti-Inflammatory Drugshttps://orcid.org/0000-0003-0439-6287МорозЕ. В.MorozE. V.

кандидат медицинских наук, заведующая 10 гастроэнтерологическим отделением

105229, г. Москва, Госпитальная пл., 3, Россия

Cand. Sc. (Med.), Head of the Gastrointestinal Department N 10

avmoroz777@rambler.ruhttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. Y.

доктор медицинских наук, заведующий лабораторией гастроэнтерологических проблем при ревматических заболеваниях

115522, г. Москва, Каширское шоссе, 34А, Россия

Dr. Sc. (Med.), Head of the Laboratories of Gastroenterological Problems with Rheumatic Diseases

aekarat@yandex.ruhttps://orcid.org/0000-0002-8531-0205КрюковЕ. В.KryukovE. V.

доктор медицинских наук, профессор, начальник

105229, г. Москва, Госпитальная пл., 3, Россия

Dr. Sc. (Med.), Professor, Head

evgenykrukov@yandex.ruhttps://orcid.org/0000-0003-4139-9954СоколовА. А.SokolovA. A.

доктор медицинских наук, профессор кафедры общей хирургии и лучевой диагностики

117997, г. Москва, ул. Островитянова, 1, Россия

Dr. Sc. (Med.), Professor of Surgery and Radiology Department

sokolov-alx@yandex.ruhttps://orcid.org/0000-0002-4843-2000АртемкинЭ. Н.ArtemkinE. N.

кандидат медицинских наук, заведующий отделением эндоскопии с рентген-операционной и группой анестезиологии-реанимации

105229, г. Москва, Госпитальная пл., 3, Россия

Cand. Sc. (Med.), Head of the Unit of Endoscopy with X-ray Operation Room and Anesthesiology and Intensive Care Group

eduarddoctor@mail.ruФГБУ «Главный военный клинический госпиталь имени академика Н.Н. Бурденко» Министерства обороны Российской ФедерацииBurdenko Main Military Clinical HospitalФГБНУ Научно-исследовательский институт ревматологии им. В.А. НасоновойV.A. Nasonova Research Institute of RheumatologyФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РоссииPirogov Russian National Research Medical University201911112019451925Copyright © Мороз Е.В., Каратеев А.Е., Крюков Е.В., Соколов А.А., Артемкин Э.Н., 20192019Мороз Е.В., Каратеев А.Е., Крюков Е.В., Соколов А.А., Артемкин Э.Н.Moroz E.V., Karateev A.Y., Kryukov E.V., Sokolov A.A., Artemkin E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/2163

Цель исследования: cравнение патологических изменений слизистой оболочки (СО) верхнего отдела ЖКТ, возникающих на фоне приёма антитромботических средств (АТС) и нестероидных противовоспалительных препаратов (НПВП).Материал и методы. Проведено сравнение данных эндоскопических исследований двух групп пациентов, принимавших АТС и НПВП. Первая группа представлена 448 больными, наблюдавшимися в гастроэнтерологическом отделении, с эрозивно-язвенными изменениями слизистой ЖКТ, возникшими на фоне приёма АТС. Вторая группа – 6431 пациент, регулярно принимавший НПВП, с ревматическими заболеваниями.Результаты. Эрозивно-язвенные изменения СО желудка и/или двенадцатиперстной кишки (ДПК) были выявлены у 168 (37,5 %) больных, получавших АТС, и у 1691 (26,3 %) больного, получавшего НПВП. Структура патологии различалась следующим образом: на фоне приёма АТС и НПВП число язв желудка составило 6,5 % и 15,5 % (p < 0,001), язв ДПК – 2,9 % и 4,9 %, сочетанных язв желудка и ДПК – 2,9 % и 2,0 %, множественных эрозий СО – 52,4 % и 15,7 % (p < 0,001), единичных эрозий СО – 35,1 % и 61,6 % соответственно. Наличие язвенного анамнеза и возраста ≥ 65 лет значительно увеличивали риск развития эрозивно-язвенных изменений у больных, принимавших АТС и НПВП: ОШ 5,182 (95% ДИ 2,701–9,942) и 3,24 (95% ДИ 2,19–5,34), 4,537 (95% ДИ 2,036–10,11) и 2,016 (95% ДИ 1,230–2,917) соответственно. Приём ИПП существенно снижал риск осложнений как для АТС, так и НПВП: ОШ 0,329 (95% ДИ 0,199–0,546) и 0,317 (95% ДИ 0,210–0,428) соответственно.Заключение. Структура патологии СО верхних отделов ЖКТ, возникшей на фоне приёма АТС и НПВП, различается. Для первой характерны множественные эрозии СО, для второй – единичные язвы антрального отдела желудка. Язвенный анамнез и пожилой возраст существенно повышают риск осложнений со стороны гастродуоденальной слизистой при использовании АТС и НПВП. Ингибиторы протонной помпы являются эффективным средством профилактики этой патологии.

Intaking antithrombotic funds (ATA) and non-steroidal anti-inflammatory drugs (NSAIDs) is one of the most frequent causes of pathology in gastrointestinal (GI) tract.The purpose of the study: comparison of pathological changes of the mucous membrane in the upper GI tract, that occur against the background of ATA and NSAIDs admission.Material and methods. Endoscopic data of two groups of patients taking ATA and NSAIDS have been compared. The first group of 448 patients from the 10th Gastrointestinal Department in N.N. Burdenko Main Military Clinical Hospital was on record from 2013 to 2017. The patients had erosive ulcerous changes of gastrointestinal mucosa, occurred against the background of the ATA admission. The second group comprised 6431 patients with rheumatic diseases. They were hospitalized in the clinic of V.A. Nasonova Research Institute of Rheumatology in the period from 2007 to 2016 and took NSAIDs regularly.Results. Duodenal and gastric ulcer changes in gastric mucosa and duodenal ulcers were identified in 168 (37.5 %) patients taking ATA and in 1691 (26.3 %) patient treated with NSAIDS. Structure of pathology varied. So, against the background of ATA and NSAIDS admission, the number of acute gastric ulceration amounted to 6.5 % and 15.5 % (p < 0.001); acute ulcers duodenal was 2.9 % and 4.9 %; combined ulcerative lesions of gastric and duodenal was 2.9 % and 2.0 %; multiple erosions of gastroduodenal mucosa were 52.4 % and 15.7 % (p < 0.001); single erosion was 35. 1% and 61.6 %. The factor of ulcer history and age ≥ 65 years old increased significantly the risk of duodenal and gastric ulcer changes in patients taking ATA and NSAIDs: OR 5.182 (95% CI 2.701–9.942) and 3.24 (95% CI 2.19–5.34), 4.537 (95% CI 2.036–10.11) and 2.016 (95% CI 1.230–2.917) respectively. Intaking of proton pump inhibitor (PPI) reduced significantly the risk of complications for both ATA and NSAIDs: OR 0.329 (95% CI 0.199–0.546) and 0.317 (95% CI 0.210–0.428) respectively.Conclusion. The structure of pathology of mucous in the upper gastrointestinal tract that arose against the backdrop of ATA and NSAIDs admission is different. The first is characterized by a multiple erosion, while the second one has single acute distal gastric ulcers. The ulcerative history and advanced age of patients increase significantly the risk of complications concerning the gastroduodenal mucosa when using ATA and NSAIDs. PPI is the effective means of preventing this pathology.

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The authors declare that there are no conflicts of interest present.