The effect of endogenous cortisol on the course of H.pylori-associated gastroduodenal diseases in adolescents

Abstract

Background. The clinical picture and course of Н.pylori-dependent gastroduodenal diseases in adolescents have some characteristics, which complicate the diagnosis and treatment. The purpose was to investigate the level of cortisol in the blood of adolescents with Н.pylori-dependent gastroduodenal diseases. Materials and methods. A group of 96 patients (15–18 years old) was formed and divided into subgroups depending on the nosology (chronic gastroduodenitis, chronic erosive gastroduodenitis, duodenal ulcer) and gender. A comparison group included children of the same age. Fibroesophagogastroduodenoscopy was used to determine the endoscopic criteria for Helicobacter pylori (HP) and to perform a shield biopsy of the gastric mucosa (antrum and body of the stomach) and duodenum. HP infection was confirmed by enzyme immunoassay with qualitative and quantitative determination of IgG antibodies to HP in blood serum (UBI MAYIWELL™, USA). Evaluating the level of cortisol in the blood was carried out using a standard test system (Immunotech, Czech Republic). Results. The total frequency of HP detection was 54.2 %. It is worth noting that only 33.3 % of adolescents with H.pylori-associated gastroduodenal diseases have toxic CagA strains, while among patients with H.pylori-associated chronic erosive gastroduodenitis, such strains were detected in 70.8 % of cases. Children with duodenal ulcer are characterized by the highest number of HP strains in biopsies of the mucous membrane — 83.3 %. The level of cortisol in the blood of adolescents with pathology of the upper gastrointestinal tract was significantly higher than that in the comparison group (906.33 ± 43.56 nmol/ml and 666.21 ± 33.42 nmol/ml, respectively; p < 0.05). The highest cortisol content in the blood was registered in patients with duodenal ulcer, with a predominance of higher indicators among adolescent boys. Significantly higher blood levels of cortisol were found in the stage of exacerbation and with a high degree of activity of the inflammatory process. Conclusions. In adolescence, inflammatory and destructive changes in the duodenal mucosa are potentiated by a high level of cortisol in the blood, it is higher in adolescent boys, with a high degree of inflammatory activity and in association with Helicobacter pylori infection.