Features of therapy of gastric mucosal erosive alterations in patients, suffering from chronic heart failure II–III NYHA functional class

Relevance. The course of complete erosions (CE) of gastric mucosa (GM) is associated with long-term recurrent inflammation, but in patients with chronic heart failure (CHF), who are forced to take antitrombotic therapy, is also with hidden gastrointestinal bleeding (GIB). Standart antisecretory drugs are not always effective in the treatment of complete erosions. The influence of drug interactions has not been excluded.

Materials and methods. The study included 185 patients in the main group (MG) with CE and 183 patients in the control group (CG) with acute erosions (AE) of the GM. Patients in both groups had CHF II–III FC according to NYHA, with a predominance of elderly men. Depending on the presence or absence of Hpinfection, patients of the MG and CG are divided into 2 subgroups. The first subgroup with a positive reaction to Hp was prescribed standard triple first-line eradication therapy for a period of 14 days in combination with Rebamipide for 3 months, after eradication for 2,5 months. 40 mg Pantoprazole once per day was prescribed as maintenance therapy. The second subgroup with a negative reaction to Hp was prescribed pantoprazole 40 mg twice per day in combination with rebamipide for 1 month, after which patients were transferred to maintenance therapy lasting 2 months: pantoprazole 40 mg once per day in combination with rebamipide. Evaluation of the effectiveness of the treatment based on the results of EGDS and clinical manifestations was performed 1, 2 and 3 months after the start of therapy.

Results. By the end of the three-month course of therapy, dyspepsia had completely disappeared in the first subgroup, and only two patients in the second subgroup complained of a feeling of heaviness in the epigastrium and belching of air. Control EGDS after 1 and 2 months of treatment showed long term epithelialization dynamics of СE in both subgroups and after 3 months, fibrin plaque on the tips of erosions was observed in 47.7 % of patients in subgroup 1 and 44.1 % in subgroup 2. On the contrary, in both subgroups of CG, there was a significant improvement in the endoscopic picture during three months of treatment and complete epithelialization of AE by the end of the course in all patients.

Conclusion. Regardless of the therapy used, patients with CHF showed a long-term recurrent course, despite the significant positive dynamics of clinical manifestations in all patients.

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