Diabetogenic gastroduodenal ulcers: features of pathogenesis, clinical picture and treatment
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Keywords

diabetes mellitus, gastroduodenal ulcers, pathogenesis, clinical picture, treatment

How to Cite

Gubergrits, N. B., Byelyayeva, N. V., & Lukashevich, G. M. (2021). Diabetogenic gastroduodenal ulcers: features of pathogenesis, clinical picture and treatment. Herald of Pancreatic Club, 2(51), 62-66. Retrieved from https://vkp.org.ua/index.php/journal/article/view/238

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Abstract

Diabetes mellitus has turned into an epidemic in modern conditions, affecting about 5.9% of the adult population in the world. Unfortunately, little attention has been paid to the features of the pathogenesis and treatment of gastroduodenal ulcers in patients with diabetes in recent years.

No correlation was found between the duration of diabetes and the onset of peptic ulcer disease. The prevalence of Helicobacter pylori in patients with diabetes is higher, and the results of eradication are worse than in patients without diabetes.

Gastric secretory function in the combined course of peptic ulcer and diabetes is likely to vary ambiguously. Some authors believe that hyperglycemia inhibits the gastric secretory function, and the ulcerative process, arising against this background in the duodenum, occurs with a decrease in both basal and stimulated gastric secretion. Other authors consider that gastric secretion indices in duodenal ulcer, on the contrary, are increased in patients with diabetes.

The most important thing in the pathogenesis is probably the violation of microcirculation in the mucous membrane of the stomach and duodenum. It is the regional blood supply adequate to the needs that provides the processes of oxidative phosphorylation and other energy-intensive processes in the mucous membrane of the gastroduodenal zone, including the restoration of the mucous-bicarbonate barrier of the stomach, as well as the physiological and reparative regeneration of epithelial and glandular cells. Upon the erosive-ulcerative process of the gastroduodenal zone in patients with diabetes, microcirculation is naturally disturbed, intra- and perivascular changes appear, which are combined with deterioration in the rheological blood properties, increase in the permeability of the vascular wall and a violation of the biogenic amines metabolism. There is a tendency to growing hypercoagulability and intravascular aggregation of erythrocytes and microthrombosis. Motor disorders, such as gastroparesis, are also important in the pathogenesis of gastroduodenal ulcers in diabetes.

V.Kh. Vasilenko et al. (1987) divide patients with gastroduodenal ulcers and diabetes into several groups by pathogenesis and clinical picture: patients with type 1 diabetes, type 2diabetes; patients who had ulcers in extreme situations (against the background of hyperacidotic or hyperosmolar coma, during surgery, etc.); patients with diabetes whose ulceration is caused by the ulcerogenic action of insulin.

Complications of ulcers in diabetes are atypical, without an obvious clinical picture.

Treatment of comorbidity of diabetes and gastroduodenal ulcers has not been developed and is carried out at the empirical level. Semi-liquid food, gastrokinetics are prescribed in the gastroparesis. Eradication therapy is mandatory upon diagnosing Helicobacteriosis. Antisecretory drugs (proton pump inhibitors) are prescribed as well. Antihypoxants, reparants, drugs that improve metabolism in the gastroduodenal mucosa are pathogenetically substantiated.

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