Volume 03 Issue 10-2023
72
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
this study consists in a detailed analysis of the psycho-emotional disorder (level of anxiety and depression), quality
of life (physical, social and psychological components) and clinical (objective data and scarring stages) indicators of
patients with duodenal ulcer in dynamics after the use of three-component therapy, including drugs such as
Quamatel and Sulpiride.
KEYWORDS
Peptic ulcer, psycho-emotional disorder, hospital anxiety and depression scale, quality of life.
INTRODUCTION
Duodenal ulcer (DU) is the most common pathology of
the gastrointestinal tract (GIT), and in modern
gastroenterology, the choice of adequate treatment
regimens is one of the most urgent problems. [3] DU is
a disease of multifactorial genesis, however, at
present, in the etiopathogenesis of the disease, great
importance is attached to the acid-peptic factor and
the infectious agent in 100% of cases [4]. Everyone
knows the postulate of K. Schwartz (1910) that “There
is no ulcer without acid” and therefore the modern
strategy for the treatment of DU is aimed primarily at
suppressing the secretion of hydrochloric acid,
neutralizing it, and protecting the mucous membrane
from the effects of aggressive factors.
Since in 1823 г. WilliamProut established the main
component of gastric juice, various methods were
proposed to neutralize hydrochloric acid. At the
beginning, antacids were developed, later -
anticholinergic drugs (non-selective), and in 1976 the
Research Article
PSYCHOEMOTIONAL STATE IN PATIENTS WITH DUODENAL ULCER
DISEASE AFTER DRUG THERAPY
Submission Date:
October 20, 2023,
Accepted Date:
October 25, 2023,
Published Date:
October 30, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue10-13
Sadikova S.I.
Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 10-2023
73
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
first histamine H2-receptor blocker cimetidine was
used for the first time, which opened a new era in
gastroenterology
in
the
treatment
of
DU,
gastroesophageal reflux disease, chronic pancreatitis.
Since several generations of histamine H2 receptor
blockers have appeared, one of the latest is famotidine
(Quamatel).
It is known that the life of a modern person is
characterized by frequent and often constant nervous
stress. Each human div adapts to emerging situations
in its own way: in some cases, changing the attitude to
emotionally significant events, in others - through a
complex mental processing of emotions that directs
the flow of excitations to visceral organs with the
formation of functional deviations, true somatic
diseases or emotionally affective states. (neurosis,
depression). At the same time, the choice of the target
organ is very wide [1,3,8], however, in this report, we
will focus only on the pathology of the digestive
organs, since in the pathogenesis of diseases such as
DU, gastric ulcer (PU) [2] are involved in the greatest
degree of psychosomatic and vegetative influences,
since the motor function of the stomach and intestines
is controlled primarily by the autonomic nervous
system [2]. This is also evidenced by diagnostically
significant changes in segmental autonomic tone in
patients with PU [7].
In connection with the above, in the treatment of PUD,
psychotropic therapy is used [1, 6, 8], most often with
tricyclic antidepressants (amitriptyline) [1, 8]. In recent
years,
among
the
drugs
that
have
a
psychopharmacological
effect,
the
atypical
antipsychotic sulpiride has been distinguished. Its main
feature is the almost complete absence of
extrapyramidal side effects. That is why it is
recommended for the treatment of the entire
spectrum of psychosomatic diseases, various forms of
depressive
syndrome,
neurosis,
including
biopsychosocial diseases of the digestive system.The
problem of studying the quality of life (QoL) of patients
with PU is given little attention. WHO experts believe
that it is especially important to study QoL in chronic
diseases that require long-term treatment. It is in these
situations that the patient needs to assess changes in
his physical, mental and social status, so the study of
QoL is relevant.
The aim of our research work was to improve the
psycho-emotional disorder and quality of life in
patients with duodenal ulcer by improving the quality
of pathogenetic therapy of psychovegetative-
dependent diseases of the digestive system.
Objective of the study: to evaluate the clinical efficacy
of the use of the drug "Sulpiride" in the complex of
three-component therapy for DU, the first component
of which was the drug " Quamatel " .
Material and research methods . The study involved 65
patients with DU, aged 18 to 68 years, with a disease
Volume 03 Issue 10-2023
74
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
duration of 1 to 10 years. Of these, 39 men and 26
women. Examination and treatment were carried out
upon admission to the hospital in the stage of
exacerbation of DU. Upon admission, all patients
underwent anamnesis of life and disease, analysis of
clinical symptoms of the disease, biochemical blood
tests, coprogram and fecal occult blood analysis, chest
X-ray, ECG, abdominal ultrasound. To assess the quality
of life of patients, the "Short Questionnaire of WHO to
assess the quality of life" was used. At the same time,
the psycho-emotional state was assessed using the
Hospital Anxiety and Depression Scale ( HADS ).
According to modern data [4] H. pylori is detected in
more than 90% of patients with DU and therefore the
definition in patients of the examined group did not
seem appropriate. Verification of the diagnosis and the
rate of scarring of the ulcer were determined
according
to
the
results
of
esophagogastroduodenoscopy (EGDFS) performed
according to the usual method. Long-term DU was
detected in 64% of patients, late-onset DU in 36% of
patients. The largest sizes of ulcers (less than 0.5 cm)
were registered in 16% of patients, medium sizes (0.5-
1.0 cm) - in 64%, large (1.1 - 3 cm) - in 20% of patients.
All patients with PUD were divided into two into 2
groups. The 1st (main) group included 33 patients who,
along with standard antiulcer therapy, received
prosulpin at a dose of 200 mg per day for 2 weeks. The
2nd (control) group included 32 people who received
only standard antiulcer therapy. All patients were
prescribed a three-component therapy, the first
component of which was the drug Quamatel eat a dose
of 20 mg 2 times a day and in group 2 in combination
with the drug Sulpirid at a dose of 200 mg per day for 2
weeks. The effectiveness of treatment and symptoms
were analyzed on days 1, 10, 20 after taking the drug.
Research results . The leading complaints when
contacting the clinic in both groups of patients were
pain in the epigastric region, heartburn, nausea,
belching, and flatulence. In 75% of patients, pain was
localized in the epigastric region. Irradiation of pain
was noted in 46% of patients, of which 61% - in the back
and lower back, 23% - in the right hypochondrium, 13% -
in the region of the heart. 71% of patients characterized
pain sensations as insignificant and average intensity.
In 82% of patients, a combination of pain and dyspeptic
syndromes was noted. In the study of the quality of life
in all patients, deviations in physical and psychological
well-being were found (Fig. No.1). As well as self-
perception, micro-social support and social well-being
are extremely unfavorable.
Volume 03 Issue 10-2023
75
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Figure #1
Index of subjective data of patients in both groups.
According to subjective complaints, the psycho-emotional state of the patients was relatively equal (1:1,5). At the same
time, complaints such as irritability (84%), sleep disturbance (94%) and anxious thoughts (93%) were observed to a
greater extent in both groups.
For a more detailed analysis of the psychological sphere, we used the HADS psychodiagnostic method(Fig. No.2,3),
which also served as a criterion for evaluating the applied psychopharmacotherapy in the main group.
Figure No.2 Comparative analysis of the HADS anxiety score in both groups
0
5
10
15
20
25
30
35
Irritability
Sleep disorders
Anxious thoughts
Mood volatility
Tearfulness
Main group (n=33)
Control group (n=32)
14.5
4.7
13.7
8.4
ON 3RD DAY OF TREATMENT
ON 20TH DAY OF TREATMENT*
Main group (n=33)
Control group (n=32)
Volume 03 Issue 10-2023
76
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
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MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
*error rate ≤0.03
Figure No.3 Comparative analysis of the HADS depression score in both groups
According to the data obtained, it follows that in the
main group, the indicators of anxiety and depression
significantly decrease on the 20th day after treatment
to 4.6, which is the norm. However, these indicators do
not show a downward trend in the control group. In
this connection, it can be concluded that the drug
Sulpirid effectively improves the psycho-emotional
state of patients with DU.
In dynamics, the analysis of subjective data showed
that in 33 patients (67.7%) a decrease in pain was noted
already on the 2nd day when using triple therapy, the
first component of which was the drug quamatel, and
in the remaining patients on the 4th and 5th -th day.
Complete relief of pain on the 5th day was noted in 31
patients (88.6%) of DU and in 5 patients the pain
syndrome disappeared on the 7th day of triple therapy
in both groups. In the main group, who received triple
therapy and sulpiride, there was a significant increase
in the quality of life, compared with the control group,
where the quality of life indicators remained
unchanged (Fig. No.4, 5).
9.2
0
8.8
7.1
ON 3RD DAY OF TREATMENT
ON 20TH DAY OF TREATMENT*
Main group (n=33)
Control group (n=32)
Volume 03 Issue 10-2023
77
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
SF1
–
physical sphere; SF2 - psychological sphere; SF3 - social sphere; SF4 -
environment. (p≥0.05)
Figure #4
Quality of life indicator in dynamics in the main group
SF1
–
physical sphere; SF2 - psychological sphere; SF3 - social sphere; SF4 -
environment. (p≥0.05)
Figure #5
Quality of life indicator in dynamics in the control group
70.3
72
76
61
53.4
56
56.3
46
SF1
SF2
SF3
СФ4
Befor treatment
20 day of treatment
SF1
SF2
SF3
SF4
72.4
78
70.6
66
70
77.3
69
64.2
Befor treatment
20 day of treatment
Volume 03 Issue 10-2023
78
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
10
P
AGES
:
72-78
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
A slight increase in the quality of life in the control
group was observed due to the use of three
component therapy for DU.
In addition, the most informative in assessing the
effectiveness of the ongoing complex treatment were
the data of endoscopic examination, so the rate of
scarring of the ulcer in patients with DU, who
additionally received sulpiride, was 0.0625±0.0018
cm2/day, and in the control group - only 0.0312± 0.0035
cm2/day (t=8). Thus, the rate of scarring of the ulcer in
the main group increased twice as compared to the
control group.
CONCLUSION
Studies have shown that the use of Sulpiride at a dose
of 200 mg / day in the complex therapy of DU, the first
component of which is Quamatel at a dose of 40 mg
per day, is advisable to use in all patients with DU with
deviated self-perception, psycho-emotional disorder
and social well-being.
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