Working Hypotheses About the Possibilities of Valvular Gastroenterology

Currently, there is a paradoxical situation where the dominant medical opinion recognizes the harmfulness of dysfunction of such barrier structures as cardia, gatekeeper, Oddi’s sphincter, heart valves, lower extremity vein valves, etc., but ignores the failure of the ileocecal locking device (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 irrigoscopy, the failure of the bauhinia valve (NBZ) was detected in 56% of cases. Despite these facts, practical and scientific medicine does not pay attention to this phenomenon. In this article, I would like to refer to the NBZ clinic, some etiopathogenetic links in the development of various pathologies of the body from the standpoint of valvular gastroenterology, to acquaint with the scientific and practical results of surgical correction of the defect, to highlight the possible perspectives of the method, i.e. to put forward working hypotheses readers to invite them to joint scientific and practical cooperation. Over 15 years of studying this problem, 281 patients aged from 6 to 67 years old have been subjected to surgical treatment for NBZ. All operations were performed according to original methods after confirming the pathology with an irrigoscopy method. In 73 patients, the surgical benefit was supplemented with correction of the identified chronic violation of duodenal patency (CNDP). According to the apt expression YaD Vitebsk [1], the gastrointestinal tract (GIT) is a one-way road. Any oncoming traffic on such a road is the road to an accident. Such one-sidedness in the gastrointestinal tract is determined by a series of valves, which are divided into two groups: absolute and relative action. Valves absolute action normally always pass the contents of the overlying departments in the underlying. Movement of the contents in the opposite direction (this will be considered reflux) will necessarily cause pathology. There are two valves of absolute action: the sphincter of the Vater papilla and the ileocecal obturator (Bauhinia valve). Valves of relative action in some conditions may allow reflux from the lower parts to the overlying ones, which is an adaptive response. From the standpoint of valvular gastroenterology, we will try to present the etiopathogenesis, the principles of treatment and the first results of certain diseases from both the gastrointestinal tract and outside it.

small intestine, lymphatic vessels and lymph nodes located in the retroperitoneal space and around the duodenum, adhesions develop around the latter, as well as in the initial part of the jejunum.
These parts of the intestine are located mesoperitoneally and do not have a mesentery, which limits their mobility and contributes to the adhesive process. Fibrous cords (due to adhesions) and enlarged lymph nodes squeeze the end section of the duodenum from the outside, which makes it difficult for the contents of the duodenum to exit, increasing the cavity pressure in it. Hypertension in the duodenum makes it difficult for secretions to escape from the organs that flow into it (from the gallbladder, pancreas, liver, stomach), which leads to chronic inflammation in these organs.
Colonization by microbes can cause an infectious process in them.
Disruption of the general condition arises from the period of the disease when absorption in the small intestine begins to suffer. Therefore, in varying degrees, it occurs in most chronic enteritis.
There are forms of chronic enteritis, which manifest exclusively general symptoms, seemingly unrelated to the intestinal tract, and only a thorough clinical examination reveals the true nature of the disease: a violation of the protein metabolism, the digestive systems of the digestive tract, fat metabolism, phospholipids, cholesterol, carbohydrate violation, vitamin, mineral metabolism, endocrine insufficiency, disorders of hematopoiesis, nervous system, pathology of the skin, lungs, cardiovascular system. For laboratory confirmation of chronic auto-intoxication, we determined such indicators as urine indican, the level of average serum molecules, lipid peroxidation, and lipid metabolism. It turned out that in case of the failure of the Bauhinia valve, the qualitative response of urine to indican is positive in 95% of cases (normally this reaction is negative), the level of medium molecules is increased in 77% of patients (on average this value exceeded the norm by 43.5%) normal rates are in 8%, b-lipoproteins -in 18%, triglycerides -in 25%, atherogenic coefficient -in 45%, serum lipid peroxidation -in 52% of patients.
These indicators prove the presence of chronic autointoxication in NBZ and indirectly confirm the theory of aging. II Mechnikov [2][3][4][5][6] as a result of prolonged autointoxication coming from the colon 2, 3. As a result of Bauginoplasty, the reaction of urine to indican turned out to be positive only in 5% of observations, but even then, after a relapse of the NBZ due to the imperfection of the procedure used at first. Studies of 147 patients with NBZ allowed us to determine the clinical picture of the disease (Table1).

Synthesis of cholesterol (cholesterol) occurs in cells of almost
all organs and tissues, but in significant amounts in the liver

Contact with Food Allergies
Allergic manifestations outside the digestive system were observed in 21% of patients with food allergies, which was present

Relationship with Asthma
According to the literature, the etiopathogenetic relationship between the gastrointestinal tract and BA is noted in 40-82%.
In this case, the following relationships are distinguished: We interviewed 169 patients with asthma. The overwhelming majority of patients had clinical manifestations of pathology, which, according to our data, corresponds to the NBZ (Table 1)

Contact with Dermatosis
The following etiopathogenetic links in the development of dermatoses are distinguished.
I. Changes in acid-base balance in the lumen of the small intestine, food ingress becomes an antigen for it. Immune complexes are formed in the intestines, including auto-tissues, which penetrate the blood and settle in various tissues, including the skin, where immediate and delayed types of hypersensitivity develop. Therefore, it seems most likely that the intestine, especially the small intestine, is the organ of the digestive tract most responsible for the development of dermatosis.
II. As a result of a violation of absorption in the small intestine, there is a shortage of many substances, in particular vitamins, whose participation in the pathogenesis of dermatosis is large.
III. Endointoxication in patients with dermatoses is manifested by a higher content of medium molecules (2-3 times compared with the norm) and therefore the use of sorbents, hemosorption, plasma exchange significantly improves the effect of therapy.
Irrigoscopy was performed in 32 patients with dermatoses, and all of them revealed a reflux of a contrast agent in the ileum (NBZ).

Communication with Rheumatoid Diseases
In rheumatology, a separate type of arthritis occurs, occurring as a complication of intestinal disease, called enterogenous arthritis. The mechanism of the relationship is not yet clear, but arthritis never precedes bowel damage. It deepens in parallel with intestinal pathology. Still allocate reactive arthritis. In this case, the infection is located outside the joint cavity. This term is used to refer to arthritis that has developed after an intestinal or urinary infection. It is believed that the pathogenesis of such arthritis is  (Table 1). Thus, a working hypothesis is being advanced that the detection and surgical correction of NBZ and HNDP may be etiopathogenetic links in the treatment of rheumatoid diseases.  (Table 3).

Communication with Diabetes
Serum with the addition of distilled water with incubation at 37°C of insulin is destroyed in the liver. We concluded, confirming the opinions of other authors, that diabetes in a large proportion of cases is accompanied by the clinic of chronic gastroenterocolitis, which, according to our data, corresponds to such organic pathology as the NBZ and KNDP. Thus, a working hypothesis is being advanced that the elimination of NBZ and HNDP in some patients with diabetes can lead to regression of the latter. I. Accordingly, the following data was studied for NBZ.
II. The growth of microflora from the "B" portion when  Table   1), suggest that the vast majority of patients in this group have a gastrointestinal valve system pathology. After the Bauhinoplasty operation, the normidal state was detected in 35% of patients (before the operation it was in 12.5%), hypoacidic in 9% (before the operation --20%), anacid-in 18% (before the operation -in 33%). The number of patients with hyperacid state increased by 2%. DGR is registered in the same patients in whom it occurred before the operation [19]. According to EGD, DGR after surgery was found in 26%, whereas before the operation -in 44% of cases. would like to add that DGR is considered by many researchers as a precancerous condition [22][23][24].

Linkage to Colon Cancer
One of the theories of carcinogenesis is Virchow's theory,   [26].
found that the activity of bile acid metabolites in feces was much higher in patients with colon cancer than in control persons 26. MQ Hill [22][23][24] notes that the concentration of bile acids in the feces in various populations correlates with the risk of developing colon cancer. In animal experiments, when colon cancer was caused by dimethylhydrazine, it was shown that an induced change in the concentration of fecal bile acids, which was caused by the diversion of bile to the cecum, was accompanied by an increase in the number of cases of colon cancer 24. From the NBZ position, the microflora in the ileum is the starting point in the development of reflux enteritis, which may further lead to colon carcinogenesis. This is confirmed by the fact that in experiments on the development of experimental colon cancer in sterile animals [27] and animals treated with antibiotics [28], the number of cancer tumors is much less than in animals with normal microflora. KS Ormantaev et al [29]. in 55 sick children with recurrent chronic inflammatory process in the ileocecal zone revealed a higher content of bile acids in feces in patients with NBZ than without it 29. The fact that with right-side hemicolectomy at the site of the confluence of the small intestine into the large intestine valve of absolute action should be formed in order to prevent cancer of the remaining colon, according to GG Nemsadze et al [25]. They noted that after the right-sided hemicolectomy was performed with ileotransversion anastomosis "side-by-side", the average level of bile acids in the dry mass of feces was 14.7 ± 3.5 mg / g, whereas before the operation it was 10.9 ± 2, 9 mg / g. After the same operation, but with the imposition of a transverse invagination anastomosis according to YaD Vitebsk [19] as more areflux, the average level of bile acids in the feces was 11.9 ± 2.6 mg / g dry weight, whereas before the operation it was 11.7 ± 2.6 mg / g. The last type of anastomosis practically did not change the concentration of bile acids in the faeces.
These examples indirectly indicate the need for the Bauhinia valve to function as an absolute valve. When NBZ, proven irrigoskopii, we conducted a study of biopsy specimens of the mucous membrane of the colon, which allowed to establish different degrees of inflammation with infiltration of lymphoid cells in almost all cases (96%), histiocytes (46%) and plasma cells (24%). Phenomena of edema occurred in 92% of cases, fibrosis -in 56%. In addition, hemorrhages, vascular congestion, as well as the proliferation of the intestinal epithelium (27%), increased mucus formation and mucosal atrophy were detected.
With fibrocolonoscopy, 86% of patients showed signs of colitis, more than half of the patients (53%) had a total character, and 33% had a regional one. The Bauhinia valve was closed in 16% of cases, gaping in 46%. With an irrigoscopy before surgery, colitis was observed in 87% of patients, with follow-up after surgeryonly in 16%. When sigmoidoscopy before the operation in 100% of cases, the phenomena of proctosigmoiditis were detected, after the operation, the effects of unexpressed colitis were noted only in 25%. With control fibrocolonoscopy, colitis was detected in 47% of patients, in 26% of patients with segmental, and in 21% of cases with diffuse. In the ileum after surgery to hold the device failed. The study of biopsy specimens of the mucous membrane of the colon during the follow-up examination also confirmed the regression of inflammation. Thus, the phenomena of fibrosclerosis were recorded in 39% of cases, round-cell infiltration -in 35%, infiltration with plasma cells -in 4%, infiltration with lymphoid cells -in 39%, edema -in 8%, proliferation of intestinal epithelium -in 35%. Thus, Bauhinoplasty in our modification significantly reduced the degree of inflammation of the colon, which generally reduces the risk of developing the cancer process. Clinical manifestations of NBZ were revealed by us in 106 patients with histologically proven colon cancer ( Table 1). The table shows that a significant proportion of