Варіанти перебігу гастроезофагеальної рефлюксної хвороби залежно від виду рефлюксу

Abstract

The purpose of the work was to study the clinical course of gastroesophageal reflux disease with acid and alkaline refluxes, to investigate the psychosomatic state, the features of endoscopic changes in the esophageal mucosa, changes in pH-measurement and gastric motility in patients with gastroesophageal reflux disease depending on the type of reflux. Materials and methods. A study of 60 patients with gastroesophageal reflux disease aged 24-65 years (mean age 44.5±5.3 years) was carried out. The main group consisted of 35 patients with gastroesophageal reflux disease with concomitant acid reflux, and the comparison group included 25 patients with verified alkaline reflux. Control group consisted of 20 practically healthy people. The groups were representative by age and sex. All patients underwent a comprehensive diagnostic program, which included a careful collection of life and medical history, questionnaires, clinical examinations, anthropometric studies, laboratory and instrumental studies. Results and discussion. Among the examined patients with gastroesophageal reflux disease with acid reflux, men predominated (60%). In contrast, the patients with alkaline reflux were dominated by female patients –76%. Most patients with alkaline reflux were overweight and had obesity of I and II degree. Тhe abdominal type of the obesity prevailed in the patients with alkaline reflux (64%). In the main group of the patients there was an increase in the number of acid reflux per day – 125±2.6, alkaline – 60±2.1 in the comparison group – 113±44.2 (p <0.01). In the control group, weakly acidic reflux, which coincided with clinical manifestations, was registered less frequently – the average daily rate was 155±24.3. The average daily number of refluxes over 5 minutes in patients with acid reflux was 19.7±3.5, with alkaline – 16.8±3.3. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes in 14 (66.7%) people: reflux esophagitis grade A (38.1%), grade B (19.1%), grade C (9.5%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). Delayed gastric evacuation is more pronounced in patients with gastroesophageal reflux disease with alkaline reflux, which can be explained by slowing of motility of the stomach and the presence of duodenostasis. In the vast majority of patients in this group, complete evacuation of contrast from the stomach occurred in a period of 3 hours or more. This allows us to conclude that the violation of the contractile ability of the stomach is one of the main factors that slows gastric evacuation, increases intragastric pressure and contributes to the development of pathological dumping of gastric contents into the esophagus. Conclusion. The combined course of gastroesophageal reflux disease with acid and alkaline reflux is characterized by specific etiopathogenetic mechanisms of development, polymorphism of clinical symptoms, which worsens the psychosomatic state and quality of life of patients. In patients with gastroesophageal reflux disease with alkaline refluxes, concomitant lesions of the pancreato-biliary system were more often diagnosed. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes (66.7%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). A hiatal hernia was found in patients with acidic (22.9%) and alkaline reflux (28.1%). Insufficiency of the lower esophageal sphincter was observed in 40% of patients with alkaline reflux, in 34.2% of patients with acid reflux with normal body weight. In gastroesophageal reflux disease with acid reflux, persistent delay in gastric evacuation is caused by persistent pylorospasm