Neuroimmune interactions for the prognosis the risk for stress ulcer formation in patients with peritonitis

Introduction

Acute gastroduodenal stress disorder-related ulcer is a major problem for treatment in patients with generalized peritonitis. Numerous studies have tried to identify some of the risk factors for stress ulcer formation in patients with peritonitis. The aim of this study was to investigate the most important changes of the immune system and neuroimmune interactions for the prognosis of the risk for stress gastroduodenal ulcer formation in patients with acute generalized peritonitis.

Methods

We studied prospectively 320 patients aged 18–86 with acute generalized peritonitis of different etiology after an emergency operation. All patients were treated with broad-spectrum antibiotics and supportive therapy. Blood was collected 1, 3, 7 and 14 days after operation to determine lymphocyte subsets, plasma concentrations of IgA, IgM, IgG, and neuroreceptors (β-adrenoreceptors and cholinoreceptors) on the surface of lymphocytes.

Results

Although most patients with acute peritonitis (94%) did not demonstrate clinical signs of ulcer, the incidence of stress ulcer was significantly higher (32% in nonsurvivors). Our findings revealed four types of neuroimmune interactions in patients with generalized peritonitis. Type I – patients (only 8% of patients) with active adrenoreceptors and cholinoreceptors; type II – patients (61%) with active cholinoreceptors in combination with blockade of β-adrenoreceptors on the surface of sensitized lymphocytes; type III – patients (16%) with active β-adrenoreceptors in combination with blockade of cholinoreceptors; type IV – patients (15%) with blockade of both β-adrenoreceptors and cholinoreceptors. Among the patients with proinflammatory complications in the postoperative period we observed mostly the III (40%) and IV (34%) types of neuroimmune interactions; and among the patients with an uncomplicated course of the postoperative period, type II (62%). In patients with stress ulcer formation in the postoperative period we diagnosed II and IV types of neuroimmune interactions. The index of stimulation of β-adrenoreceptors activity by adrenaline was decreased to 1.7 ± 0.09, and the index of stimulation of cholinoreceptors on the surface of lymphocytes by carbocholine was normal (1.62 ± 0.09 in type II) or below the normal level (0.8 ± 0.07). We did not reveal stress gastroduodenal ulcers in patients with I and III types of neuroimmune interactions.

Conclusion

Dysfunction of neuroimmune interactions may explain a proneness towards weaker defense and formation of the stress disorder-related acute gastroduodenal ulcer. One of the contributing factors to the development of the stress ulcer in patients with acute generalized peritonitis is the condition of β-adrenoreceptors and cholinoreceptors on the surface of the lymphocytes.