JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Normal va Pathologist of Physiology Department , Pathologist of Physiology Assistant :
Хаккулова Марта Алишеровна
Students :
Berdieva E'zoza, Sokhibova Shahzoda
Tashkent state Medical Academy
CHARACTERISTICS OF THE PERI-GASTRIC MICROFLORA AND DEGREE OF
GASTRIC DYSBIOSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
The immunity of the organism is closely related to the function of the normal microflora, which
is currently considered as a peculiar organ of the immune system. This is why maintaining the
ecological balance in the gastrointestinal tract is so important. It is known that the loss of normal
microflora function, with the subsequent activation of opportunistic pathogens, causes
disruptions in both local and systemic immune responses [3,5, 8, 12, 13, 14, 15, 16, 17].
The possible role of opportunistic flora as a causative or triggering factor is discussed in the
context of a number of autoimmune diseases: rheumatoid arthritis [10, 11], Bechterew's disease
[2], and systemic vasculitis [7]. Most authors, however, place the greatest emphasis on
exogenous infections, ignoring the role of opportunistic microflora, which can serve as a source
of endogenous infection and a powerful antigenic stimulus [6, 18, 19, 20]. There are few works
that address the state of gastric microflora in the context of immune disturbances in patients with
rheumatoid arthritis (RA). Therefore, identifying the role of gastric microflora in the
development of immune disturbances in RA patients is a relevant task.
Objective of the study
: To examine the state of the mucosal microflora of the stomach in
patients with RA, taking into account the degree of disease activity.
Materials and Methods
: 159 people aged 19 to 83 years were examined. Among the patients,
there were 128 women and 31 men, with a female-to-male ratio of 4.13:1. The average age was
55 ± 0.86 years. The diagnosis of RA was confirmed in all cases according to the criteria of the
American College of Rheumatology [1]. Of the patients, 23 (22.12%) had stage 1 disease activity,
63 (60.58%) had stage IX, and 14 (13.46%) had stage III. According to the course of the disease,
patients were classified as follows: slow-progressing course in 94 (90.38%) patients and rapid-
progressing course in 10 (9.62%) patients.
Joint Form of RA was diagnosed in 95 (100%)
patients. Radiologically, stage I RA was detected in 31 (29.81%), stage II in 46 (44.23%),
stage III in 26 (25.00%), and stage IV in 1 (0.96%) patient.
The study included standard clinical and radiological examinations, microbiological analysis of
stool and urine, endoscopic examination (using an "Olympus" device) of the stomach and
duodenum with biopsy of the mucous membrane, and microbiological examination of the
mucosal biopsy samples (MBS) of the stomach and gastric juice. Isolation and identification of
microorganisms (MOs) were carried out using standard methods. Gastric and duodenal dysbiosis
was characterized according to the criteria proposed by V.V. Chernin and co-authors [9].
Results of the Study
:
When examining the gastric mucosal biopsies of RA patients,
peptostreptococci
were more
frequently isolated in 71.4% of cases, followed by
staphylococci
and
Escherichia coli
in 50%,
Klebsiella
in 42.8%,
streptococci
in 35.7%,
enterococci
and
micrococci
in 21.4%, and more
rarely
Pseudomonas
and
bacilli
in 14.2%.
Candida
yeast-like fungi were found in 8.3% of cases,
with colony counts ranging from 2.77 to 10 lg CFU/g and combinations of 2 to 5 types of
microorganisms.
Figure 1 shows the data on the quantitative characteristics of the peri-gastric microflora.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Fig. 1. Quantitative characteristics of the peri-gastric microflora of the stomach in patients
with RA
When assessing the colonization of the gastric mucosa in RA patients in quantitative terms, the
following results were obtained:
Klebsiella
were isolated at 10 lg CFU/g,
Pseudomonas
at 8 lg
CFU/g,
Escherichia coli
at 7.47 lg CFU/g,
Streptococci
at 5.7 lg CFU/g,
Enterococci
at 4.33 lg
CFU/g,
Bacilli
at 4.14 lg CFU/g,
Staphylococci
at 3.87 lg CFU/g,
Peptostreptococci
at 3.68 lg
CFU/g,
Micrococci
at 3 lg CFU/g, and
Candida
at 2.77 lg CFU/g.
Therefore, in all examined patients, there was a high level of both resident and opportunistic
microflora, indicating the development of dysbiosis in the mucosal microflora (V.V. Chernin et
al., 2011).
The results of studying the spectrum and frequency of microorganism occurrence depending on
the degree of activity of the joint syndrome are shown in Figure 2.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Fig. 2. Spectrum and frequency of microorganism occurrence in the mucosal layer in
patients with RA depending on disease activity
In RA patients with stage I disease activity, the following frequency of microorganism
occurrence was found in gastric juice:
Peptostreptococci
– 100%,
Staphylococci
– 80%,
Streptococci
and
Escherichia coli
– 40%,
Bacilli
,
Klebsiella
,
Candida
, and
Enterococci
– 20%.
In RA patients with stage II disease activity, the following frequency of microorganism
occurrence was found in the gastric mucosa: approximately equal proportions of
Escherichia coli
,
Klebsiella
, and
Peptococci
– 55.5%,
Staphylococci
and
Streptococci
– 33.3%,
Enterococci
and
Pseudomonas
– 22.2%,
Bacilli
– 11.1%.
Therefore, in RA patients, the frequency of occurrence of microorganisms characteristic of the
mucosal flora and opportunistic microorganisms slightly decreases as the disease activity
increases.
The quantitative aspects of the mucosal microflora in RA patients were also analyzed depending
on the degree of activity of the inflammatory process in the joints. The data are presented in
Figure 3.
As shown in Figure 3, in RA patients with stage I disease activity,
Klebsiella
were isolated at 12
lg CFU/g,
Streptococci
at 5.03 lg CFU/g,
Staphylococci
at 4.02 lg CFU/g,
Enterococci
at 4 lg
CFU/g,
Peptostreptococci
at 3.39 lg CFU/g,
Bacilli
at 3.14 lg CFU/g,
Candida
at 2.77 lg CFU/g,
and
Escherichia coli
at 2.15 lg CFU/g.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
In patients with stage II disease activity,
Escherichia coli
and
Klebsiella
were isolated at 9.6 lg
CFU/g,
Pseudomonas
at 8 lg CFU/g,
Streptococci
at 6.15 lg CFU/g,
Bacilli
at 5.14 lg CFU/g,
Enterococci
at 4.5 lg CFU/g,
Peptostreptococci
at 3.98 lg CFU/g, and
Staphylococci
at 3.66 lg
CFU/g.
Fig. 3. Quantitative characteristics of the peri-gastric microflora of the stomach in patients with
RA depending on disease activity
Therefore, in general, in RA patients, with an increase in disease activity, there was a
quantitative increase in the number of cultures of both resident mucosal microflora and non-
resident (anaerobic gram-positive cocci, opportunistic flora) microflora, which fits the concept of
mucosal dysbiosis syndrome.
An assessment of the degree of dysbiosis of the mucosal microflora was performed, and the
results are presented in Figure 4.
Fig. 4. Mucosal flora dysbiosis in patients with RA
As seen in the figure, 71.4% of RA patients were found to have mucosal microflora dysbiosis of
varying severity (according to the classification of intra-luminal dysbiosis of the gastroduodenal
zone by E.A. Beyul and I.B. Kuvaeva). The following table presents data on the severity of
dysbiosis of the mucosal microflora depending on disease activity.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
It was established that in RA patients, the severity of dysbiotic shifts in the peri-gastric
microflora increases with the rising degree of activity of the inflammatory process in the joints.
Thus, in patients with stage I RA activity, stage III dysbiosis was found in 20% of patients, while
in patients with stage II RA activity, stage III dysbiosis was found in 55.5% of patients.
The development of gastric dysbiosis manifests as a change in the protective-barrier potential of
this zone, as the microflora of the biotope performs a protective function – colonization
resistance [4]. Another important function of normal microflora is the provision of immune
defense [8]. It is likely that in the condition of dysbiosis, changes occur in the immune defense of
the div, which leads to disruptions in the immune-inflammatory response. Thus, it becomes
evident that the development of dysbiosis in the gastroduodenal zone should have a certain
impact on the course of rheumatoid arthritis, as shown by our research. A clear relationship is
observed between the severity of dysbiosis and the degree of activity of joint pathology. The
higher the activity of joint pathology, the more pronounced the gastric dysbiosis, and vice versa.
Conclusions:
RA patients show dysbiotic changes in the stomach. The severity of dysbiosis is directly
dependent on the activity of joint pathology.
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JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 15, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
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