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
Copyright© 2021
Vladimir Leonidovich Martynov.
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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 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 ( 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) - Analyzing the clinical manifestations before and after surgery, one can note a sharp regression of gastroenterocolitic complaints ( 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.
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
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