Imbalance of Aggressive and Protective Factors in Patients with Gastroduodenal Pathology Associated with Candida Infection

Introduction. Gastrointestinal diseases combined with mycosis contamination are issue of the day. First of all disorder of anti-fungal resistance makes for the increase of the number of patients with such diseases. Mucous mucopolysaccharides, normal mucous flora, peristaltic activity and acid-enzymatic barrier of the upper gastrointestinal tract are natural factors of non-specific anti-fungal resistance of human organism. There is no consensus of opinion among the researchers regarding the reduced gastric acidity as a factor of the Candida proliferation. Candida mucosal injury is believed to be associated with hypoacid gastric status. However, some researchers (K. Wang et al., M.K. Jung et al.) do not support this point of view. Therefore, the objective of our study was to investigate the factors of aggression and defence of gastric contents, its role in inflammatory, erosive and ulcerative diseases of the upper gastrointestinal tract combined candidiasis contamination. Materials and Methods. 93 patients with inflammatory, erosive and ulcerative diseases of the upper gastrointestinal tract combined candidiasis contamination were studied. Selection criteria were IV degree of Candida contamination of the tongue scraping and/or the presence of macroscopic lesions of esophageal and gastric candidiasis symptoms with microbiological confirmation. All patients were divided into 2 groups: 33 patients with oropharyngeal candidiasis (I group) and 50 patients with candidiasis of the esophagus and/or stomach (II group). The latter group included IIa subgroup (patients with superficial candidiasis, n = 14) and IIb subgroup (patients with invasive candidiasis, n = 36). The control group consisted of 10 patients without pathological fungal growth. The concentration of pepsin, glycoproteins, sialic acid, fucose, hexosamine was studied in gastric content. Statistical analysis of the results of research carried out using software package SPSS 13.0 for Windows. Results. Comparative analysis of the secretor activity of the stomach showed that the lowest level of pepsin was revealed in patients of the IIa subgroup regardless of gastric acidity. It was 1.4 times lower in patients both I group and control group (p < 0.05), and 1.5 times lower in patients in the IIb subgroup (p < 0.05). The similar situation concerning the level of sialic acid was found in examined patients. For example, sialic acid was 1.8 times lower significantly lower in IIa group compared to I group and 1.3 times lower compared to the control group (p < 0.05). It was found the increase of hexosamine (p < 0.05), fucose (p < 0.05) and the decrease of glycoprotein (р > 0.05) in I group regardless of the Candida prevalence. The analysis depending on the acidity of gastric juice showed that the majority of patients had normal acidity of stomach (pH = 1.96 ± 0.90). Hypoacidity (pH = 7.45 ± 0.69) was revealed in one-third of patients of IIa group, which was in 2 times often than in I and control group. It was established that patients with normal acidity had decrease of glycoproteins (almost by 40.0 %) compared to the control group (p < 0.05). Patients IIa group had a significant decrease of level of sialic acids compared with the other groups and the increase of hexosamine almost in 2 times compared to the control group (p < 0.05). Fucose and pepsin level was the same in groups, but the lowest values f these parameters are noted in the IIa group. Thus, these patients had normal function of the principal cells and low function of surface epithelial cells of the gastric mucosa compared to the control group. The patients of II group with low acid-producing function had the decrease levels of sialic acids (by 32.0 %), hexosamine (by 41.0 %) and glycoproteins (by 29.0 %) compared with patients of I group due to patients with superficial candidiasis (by 61.0 %, and 44.0 % , 43.0 % , respectively). The decrease of pepsin reduction was greater in patients of IIb group (by 40.0%) compared to I group. Fucose level did not differ significantly in groups. Therefore, it was revealed the decrease of fermentative function, acid-productive function of parietal cells, and function of surface epithelial cells in these patients. Conclusions: 1. The majority of patients with candidiasis and gastroduodenal disorders had the disproportion of the carbohydrate components of polymer structure of the mucous gel. 2. The collapse of polymer gel structure reduces resistance of glycoprotein actions to pathogenic factors, such as Candida. It contributes to disorder of regenerative mechanisms and the formation of the pathological process in the gastric mucosa. 3. Disorders in antifungal resistance occur in patients with disorder the barrier function of the stomach, such as decreased synthesis of sialic acid (by 49.9 %) and hexosamine (by 36.6 %). It is the most typical for invasive candidiasis associated with secretor deficiency