Клінічна характеристика поєднаного перебігу хронічного обструктивного захворювання легень та гастроезофагальної рефлюксної хвороби

Abstract

The comorbid diseases can occur at any stage of bronchial obstruction, and, regardless of the severity or phase of chronic obstructive pulmonary disease, significantly affect disability, increase the frequency of hospitalizations, and increase the cost of medical care. The presence of concomitant gastroesophageal reflux disease in patients with chronic obstructive pulmonary disease is an independent aggravating risk factor for exacerbations and is associated with health deterioration of this group of patients. The purpose of the study was to study the features of the clinical course of chronic obstructive pulmonary disease in combination with gastroesophageal reflux disease. Materials and methods. Retrospective analysis of 138 patients who were treated in the pulmonology department for exacerbation of the disease and outpatient treatment by a gastroenterologist was carried out. 3 groups of patients were formed: 1 group (n=60) – patients with chronic obstructive pulmonary disease in combination with gastroesophageal reflux disease, 2 group (n=42) – patients with chronic obstructive pulmonary disease without signs of gastroesophageal reflux disease, who were treated in the pulmonology department for exacerbation of the disease and 3 group (n=36) – patients with gastroesophageal reflux disease who were treated on an outpatient basis. The patients were similar in age, stage of disease and duration of illness. The average age of the patients was 55±1.64. It should be noted, regarding the gender characteristics of the groups, that among the examined patients by gender, men predominated – 78.4% (80 out of 102). Results and discussion. The main clinical and anamnestic features of the combined pathology were studied. The significance of the assessment of functional changes in spirometry indexes in this category of patients is described. A significant decrease in external respiration function was revealed in the indicators of the external respiration function in patients of all groups. In the patients with chronic obstructive pulmonary disease in combination with gastroesophageal reflux disease the frequency of exacerbations increases. These exacerbations were associated with the presence and severity of gastrointestinal symptoms, namely increased heartburn, acid regurgitation causes worsening of respiratory symptoms, until the exacerbation of the disease with subsequent hospitalization. Also the length of stay in the hospital of the patients in this group increased by 1.5±0.4 days, which is associated with a severe exacerbation of chronic obstructive pulmonary disease and the need to use a double dose of glucocorticoids to control the symptoms of respiratory failure. Among the complaints of patients with combined pathology, extraesophageal manifestations of gastroesophageal reflux disease prevailed. Conclusion. The presence of concomitant gastroesophageal reflux disease in patients with chronic obstructive pulmonary disease expands and aggravates the clinical manifestations of the underlying disease