Methods. 36 adult patients, 5 with acute and 29 with chronic spontaneous urticaria were examined with upper gastrointestinal endoscopy (UGIE) and HP-testing in gastric biopsies, before and after treatment of the observed abnormalities.
Results. HP was found in 26 patients, or 72,2% (54,8; 85,8), what was less than across able-bodied population of Moscow - 87,9% (85,6; 90,0)1, difference insignificant. Wherein EU were found in 50,0% (32,9; 67,1) of patients, and gastric erosions in 41,7% (25,5; 59,2), what was 6,1 times more than in 1311 asymptomatic volunteers - 6,8% (5,5; 8,3)2. Two patients with most severe urticaria had duodenal ulcer. Despite these facts, only 23 patients (15,3%) reported mild gastrointestinal complaints after thorough questioning.
All 26 HP-positive patients received eradication therapy, and 4 HP-negative patients with EU received only antacid and antisecretory therapy. Second HP-determination by PCR after the therapy was carried out only in 13 patients with chronic spontaneous urticaria (11 HP-positive and 2 HP-negative at first UGIE, 10 patients with EU), as only 13 agreed for a new examination. Where in 7 from 11 HP-positive patients eradication was successful, and in 4 failed. From 7 patients with successful eradication remission was achieved in 2 cases, and in 5 cases there was no remission. In 4 patients with failed eradication remission was achieved also in 2 cases, and in 2 cases there was no remission. Fisher exact test with 1-tailed p=0,47, 2-tailed p=0,58 showed highly insignificant result of eradication therapy in the treatment of urticaria in followed patients.
At second UGIE, 3 patients from 10 with EU appeared with healed erosions. All of them showed complete remission of symptoms. Whereas 7 patients with unhealed EU, had no improvement at all. Fisher exact test showed significant difference with 1-tailed and 2-tailed p=0,008. Patients with acute spontaneous urticaria were not included in the statistical tests due to high possibility of spontaneous remission.
Conclusions. Erosions of upper gastrointestinal mucosa seem to have a very important role in the development of spontaneous urticaria, independently from HP.
2. Toljamo K. Gastric Erosions - Clinical Significance and Pathology. A long-term Follow-up Study. Acta Universitatis Ouluensis. D, Medica (1152). University of Oulu, 2012. p. 27.