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Research Article | DOI: https://doi.org/10.31579/2690-8794/115
Doctor of Medical Sciences, Associate Professor, National Research Nizhny Novgorod State University, Russia.
*Corresponding Author: Martynov Vladimir Leonidovich, Doctor of Medical Sciences, Associate Professor, National Research Nizhny Novgorod State University, Russia.
Citation: Martynov Vladimir Leonidovich (2022) Pathological consequences of the failure of the Bauhinia flap as possible causes of the development of allergies and dermatoses. J, Clinical Medical Reviews and Reports. 4(3); DOI: 10.31579/2690-8794/115
Copyright: © 2022, Martynov Vladimir Leonidovich, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 15 November 2021 | Accepted: 22 December 2021 | Published: 06 January 2022
Keywords: bauhinia flap; lipid metabolism; dermatoses
Currently, there is a paradoxical situation when the prevailing opinion in medicine recognizes the harmfulness of dysfunction of such barrier structures as the cardia, the gatekeeper, the sphincter of Oddi, heart valves, valves of the veins of the lower extremities, etc., but ignores the failure of the ileocecal locking apparatus (Bauhinia valve) as a possible cause of the pathology of the digestive system, as well as various extraintestinal diseases. According to our data, based on the analysis of 976 irrigoscopies, the failure of the Bauhinia valve (NBZ) was detected in 56% of cases.
Currently, there is a paradoxical situation when the prevailing opinion in medicine recognizes the harmfulness of dysfunction of such barrier structures as the cardia, the gatekeeper, the sphincter of Oddi, heart valves, valves of the veins of the lower extremities, etc., but ignores the failure of the ileocecal locking apparatus (Bauhinia valve) as a possible cause of the pathology of the digestive system, as well as various extra intestinal diseases. According to our data, based on the analysis of 976 irrigoscopies, the failure of the Bauhinia valve (NBZ) was detected in 56% of cases. We assign one of the leading roles in the digestive system to the ileocecal obturator, which separates the functions of the small and large intestines, isolating the small intestine from the reflux of the colon contents, which differs sharply in chemical composition, physical state and bacterial spectrum. As a result of NBZ, billions of microbes of the large intestine are thrown into the small intestine, "colonization" of the small intestine by allochthonous (foreign) microorganisms occurs, which leads to the development of putrefactive and fermentative processes in the small intestine. Waste products of microorganisms - indole, phenol, cresol, skatole, pyrocatechol, carbolic acid, hydrogen sulfide, mercaptan, ethane, methane, etc. - affect the mucous membrane of the small intestine and, being absorbed into the blood, cause autointoxication. These metabolites cannot be detoxified enough, especially in liver disease. With toxic, invasive and often necrotic properties, microbes contribute to the destruction of the intestinal wall, as well as dystrophic, destructive and necrotic changes in the mucous membrane. In this case, the barrier role of the intestinal wall is violated. The intestine becomes the entrance gate of infection, as evidenced by nonspecific bacteremia in patients with intestinal dysbiosis and the formation of foci of endogenous infection. Lymphoid tissue along the gastrointestinal tract also suffers as a result of the chronization of the process, and the result is a deficiency of immunoglobulins A and M. The body becomes less protected against microbial aggression. Studies of lymphoid tissue associated with the gastrointestinal tract distinguish three main groups of immunological elements: lymphoid follicles located throughout the intestinal tube, plasma and T-lymphoid cells that diffusely infiltrate the mucous membrane of the digestive system, and small unidentified cells. It was found that in 82.4% of patients with chronic colitis, in 70% of patients with chronic enterocolitis, there is a pronounced decrease in the immunological reactivity of the body in diseases of the gastrointestinal tract. Violation of the general condition occurs from the period of the disease when absorption in the small intestine begins to suffer. Therefore, to varying degrees, it occurs in most chronic enteritis. There are forms of chronic enteritis, which are manifested exclusively by general symptoms that at first glance have nothing to do with the intestinal tract, and only a thorough clinical examination reveals the true nature of the disease: a violation of protein metabolism, enzymatic systems of the gastrointestinal tract, fat metabolism, phospholipids, cholesterol, carbohydrate disturbance, vitamin, mineral metabolism, endocrine insufficiency, disorders of hematopoiesis, nervous system, pathology of the skin, lungs, cardiovascular system. Many authors recognize the fact of ascending retrograde infection of the mucous membrane of the small intestine with the failure of the Bauhinia valve (NBZ). This pathological condition is called "bacterial overgrowth syndrome (SIBO)". Currently, SIBO is recognized as a key pathogenetic mechanism in the development and persistence of many diseases of the digestive tract and associated extra-digestive conditions (bronchial asthma, dermatological atopy, diabetes mellitus, autoimmune allergic conditions, precancerous conditions, etc.).
The study was carried out on the basis of the surgical department of the City Clinical Hospital No. 12, Nizhny Novgorod, from September 2014 to December 2014. Over a period of more than 30 years, bauginoplasty was performed in 565 patients according to the methods of Professor V.L. Martynov. Laboratory confirmation of chronic autointoxication is proved by such indicators as urine indican, the level of medium blood serum molecules, lipid peroxidation, lipid metabolism. Determination of hydrogen in exhaled air using a Gastrolyser apparatus with lactulose loading before surgery and on the 7th day after surgery was performed in 20 patients (12 women, 8 men) with NBZ. To determine the antimicrobial resistance of the organism in a group of 20 patients with NBZ, the content of antibodies to peptidoglycan of Staphylococcus aureus (strain 885, solubilized by ultrasound) was studied. Each trial was performed in 3 repetitions, calculating the average result. Peptidoglycan is a structural component of the cell wall of all bacteria, which, in addition to its individual features, has a certain immunological commonality, which makes it possible to indirectly judge the content of antipeptidoglycan antibodies in general.
Of 565 patients with NBZ, a qualitative urine reaction to indican was positive in 95% of cases (normally this reaction is negative). Before and after surgery, this reaction was determined in 24 patients. In all 24 patients before surgery, the qualitative urine reaction to indican was assessed as positive; after bauginoplasty (BP), this reaction was positive only in 4 patients (5%). The level of medium molecules (USM) was increased in 82% of patients (on average, this value was 43.5% higher than the norm). Before and after PD, serum USM was detected in 20 patients. Normal indicators before and after PD were found in 1 case. USM decreased in comparison with preoperative in 16 patients. Of the 16 investigated with a decrease in serum USM, in 7 this decrease reached normal values, in 9 the norm was not achieved. Under NBZ conditions (N = 193), normolipidemia was detected in 20%, hyperlipidemia - in 72%, hypolipidemia - in 8% of patients. In the absence of reflux into the small intestine from the colon (in patients after PD), normolipidemia was observed in 84%, hyperlipidemia - in 16% of patients. It was revealed that the content of antibodies to the specified antigen was higher than in practically healthy people (positive control) in 8 patients (40%), it was lower in 12 patients (60%). An increase in the content of antibodies by more than 2 times compared with healthy ones was noted in 3 patients (15%). On the basis of this study, it can be assumed that in most (60%) patients with NBZ, a decrease in the intensity of immunity to microbial antigens is observed. After surgical correction of NBZ in 1–2 years, the content of antibodies to peptidoglycan in these same patients was higher than in practically healthy people (positive control) in 12 (60%), less in 8 (40%). The content of antibodies more than 2 times compared with healthy ones was noted in 9 patients (41%). Average values of VDT with lactulose loading in patients with NBZ: basal hydrogen excretion (ppm) - 1.9; after 15 min. after exercise - 4.1; after 30 min. - 6.1; after 45 min. - 27.3; after 60 min. - 34.7; after 75 min. - 67.8; after 90 min. - 87.2; after 105 min. - 85.4; after 120 min. - 79.3. On the 7th day in the early postoperative period, in the absence of antibiotic therapy, urine indican was negative in all operated patients. The results of VDT with lactulose loading after PD are as follows: basal hydrogen excretion (ppm) - 2.1; after 15 min. after exercise - 3.9; after 30 min. - 5.1; after 45 min. - 5.3; after 60 min. - 9.7; after 75 min. - 21.3; after 90 min. - 25.1; after 105 min. - 37.3; after 120 min. - 35.4.
With NBZ, patients develop SIBO, chronic autointoxication, antimicrobial resistance of the body decreases, which can cause many pathological conditions and nosological forms, including allergies and dermatoses. Bauginoplasty is an etiopathogenetic method of their correction.
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