Barrett’s esophagus and comorbid pathology

Aim. To analyze behavioral and socioeconomic risk factors for noncommunicable diseases in young people with comorbidities.Material and methods. The population sample included 1415 people. Comorbid pathology was considered a combination of ≥3 diseases. Comorbid pathology was detected in 105 examined people.For comparison with comorbid patients, a group of healthy individuals without any of the studied diseases was formed (n=162).Results. When assessing the main socioeconomic and behavioral characteristics, healthy individuals more often report a good self-perceived health compared to individuals with comorbid pathology, while no differences were found for poor self-perceived health between the groups. Individuals with a combination of ≥3 pathological conditions were more likely to smoke, and also more often had manifestations characteristic of eating disorders, namely abdominal obesity (AO), overweight, class I and II obesity. Morbid obesity was recorded only in individuals with comorbid pathology. According to univariate regression analysis with standardization by sex and age, comorbid pathology was associated with smoking, AO and a good self-perceived health. When including socioeconomic and behavioral characteristics in the regression model, the probability of comorbid pathology increased by >3 times in smokers, slightly <3 times in men, 2,5 times in AO and with a worse self-perceived health, and was also associated with an increase in age by 1 year.Conclusion. Among young people, comorbid pathology is associated with male sex, smoking, AO and a worse health self-perception compared to healthy individuals.

The aim of study was to study the features of the adipokine blood profile in young people with comorbid pathology.Material and methods. A cross-sectional population survey of Novosibirsk was conducted. The population sample included 1415 people, including 47 % of men. Comorbid pathology was considered a combination of 3 or more pathological conditions (CHD, AG, CB, hyperLDL-C, decreased renal function and type 2 diabetes). Adipokine levels in the blood were determined using the multiplex analysis method on a Milliplex multiplex analyzer (Merck, Millipore).Results. When conducting a univariate logistic regression analysis, it was found that the presence of comorbid pathology was associated with an increase in amylin by 1 pg/ml (p < 0.0001), ghrelin by 1 pg/ml (p = 0.016), resistin by 1 ng/ml (p = 0.001), IL-6 by 1 pg/ml (p = 0.005), C-peptide by 1 ng/ml (p = 0.024) and a decrease in PYY by 1 pg/ml (p = 0.007). In multivariate regression analysis in model 1 (gender, age, OT, resistin, IL-6, and PYY), the chance of having comorbid pathology increased by 15 % with an increase in age by 1 year (p = 0.011) and by 2.5 % with a decrease in PYY by 1 pg/ml (p = 0.005); in model 2 (gender, age, WC, resistin, IL-6, and C-peptide), the chance of having a comorbid pathology increased by 13 % with an increase in age by 1 year (p = 0.001), by 0.1 % with an increase in resistin levels by 1 ng/ml (p = 0.046), by 12 % with an increase in IL-6 levels by 1 pg/ml (p = 0.041), and by 116 % with an increase in C-peptide levels by 1 ng/ml (p = 0.019).Conclusions. In young people, the presence of comorbid pathology is associated with an increase in the blood of amylin, ghrelin and a decrease in the level of PYY, responsible for appetite regulation, as well as with an increase in the levels of resistin, IL-6 and C-peptide, involved in the formation of insulin resistance.

Objective — to identify the relationship between changes in the concentration of vitamins A, E, D, magnesium content, and comorbid pathology in adolescent girls with menstrual function disorders. Materials and methods. Examinations involved 237 girls with menstrual function disorders aged 11—18 years. Oligomenorrhea (OM) was diagnosed in 103 patients, and abnormal uterine bleeding (AUB) in 134 girls. Results and discussion. Comorbid pathology was revealed in most patients, regardless of the type of menstrual function disorder. Endocrine system disorders were the most frequent comorbidities. In girls with OM, comorbid endocrine disorders were accompanied by a decrease in the levels of vitamins A (pu < 0.01) and E, due to decrease in the frequency of their elevated indicators (pφ < 0.03). At the same time, mostly normal magnesium levels were registered (pφ < 0.001) due to a decrease in the frequency of its reduced and elevated levels compared to patients without pathology. In girls with AUB, comorbid endocrine system pathology was accompanied by decrease in the frequency of optimal levels of 25(OH)D3 (pφ < 0.03), and comorbid pathology of the neuro-­psychiatric sphere was accompanied by decrease in the frequency of elevated levels of vitamins A (pφ < 0.01) and E (pφ < 0.03) compared to girls without pathology. Regardless of the type of menstrual disorder, the greatest number of changes in the vitamin status were found in girls with comorbid pathology of the endocrine system. In patients with OM, the retinol levels were lower than in girls with AUB (pφ < 0.01), and a decrease in tocopherol levels was observed (pφ > 0.05). In girls with AUB, elevated levels of vitamin A (pφ < 0.03), vitamin E (pφ < 0.04), and moderate vitamin D deficiency (pφ < 0.03) were more frequently registered compared to girls with OM. Vitamin D deficiency in girls with abnormal uterine bleeding was less frequently registered compared to patients with oligomenorrhea (pφ < 0.05). It should be noted that comorbid pathology of the digestive system in abnormal uterine bleeding was mostly often accompanied by the decreased tocopherol levels (pφ < 0.05) and normal magnesium values (pφ < 0.04) compared to patients with oligomenorrhea. Conclusions. The study revealed a correlation between fluctuations in the content of vitamin status components and comorbid pathology in girls with menstrual disorders. The most pronounced changes in oligomenorrhea were found under conditions of concomitant pathology of the endocrine system, while in abnormal uterine bleeding, they were identified in the presence of endocrine disorders and disturbances in the neuro­psychiatric sphere. The combination of oligomenorrhea and endocrine pathology, as well as abnormal uterine bleeding and nervous disorders, is accompanied by a decrease in retinol and tocopherol reserves, creating conditions for the deterioration of compensatory­adaptive reactions of the body by suppressing the low-­molecular-­weight link of the antioxidant defense system. Abnormal uterine bleeding and concomitant endocrine disorders are associated with more pronounced moderate vitamin D deficiency.

Актуальність. Захворювання гепатобіліарної системи — одна з найбільш поширених проблем педіатричної гастроентерології. Захворювання біліарного тракту (БТ) супроводжуються стійкими змінами обміну ліпідів, що сприяє тривалому холестазу і прогресуванню біліарної патології. Мета дослідження — вивчити ефективність застосування препарату Урсофальк® у комплексній терапії захворювань БТ і коморбідних станів у дітей. Матеріали та методи. У міському гастроентерологічному відділенні м. Харкова обстежено 55 дітей віком від 5 до 18 років (31 дівчинка та 24 хлопчика). Критерії включення пацієнтів у дослідження: захворювання БТ, що супроводжуються біліарним сладжем (БС) і порушенням ліпідного профілю (ЛП) сироватки крові. Діагностичний комплекс включав: аналіз клінічних даних, УЗД органів черевної порожнини, біохімічне дослідження сироватки крові («печінкові проби», ЛП). Усі діти отримували комплексне лікування з урахуванням коморбідної патології. Тривалість курсу терапії — 1 місяць. Пацієнти були розділені на дві групи залежно від жовчогінної терапії: 1-ша (основна) група отримувала традиційні жовчогінні засоби, 2-га (група порівняння) — препарат Урсофальк®. При статистичній обробці використані ліцензовані програмні продукти (Statistica, Excel). Результати. Клінічні прояви у дітей груп спостереження були представлені больовим і диспептичним синдромами. У всіх обстежених виявлено коморбідні стани і наявність БС до початку лікування. Після закінчення курсу лікування відзначалася позитивна динаміка клінічних симптомів, лабораторних показників і гомогенності структури жовчі. Застосування в комплексній терапії Урсофальку® дозволило повністю компенсувати відчуття тяжкості та іррадіацію болю, тоді як у дітей групи порівняння зберігалися больовий синдром, тяжкість у правому підребер’ї, диспептичні скарги. Слід зазначити, що застосування Урсофальку® дозволяє також нормалізувати структуру жовчі і біохімічні показники, що характеризують ліпідний обмін. Зареєстровано вірогідно (p < 0,05) більш виражений ефект зменшення частоти порушень гомогенності жовчі в основній групі — на 65,5 % порівняно з групою порівняння — 27,3 %. Позитивна динаміка біохімічних показників при контрольному обстеженні відзначалася в обох групах пацієнтів, при цьому вірогідно (p < 0,05) більш вираженими були зміни в групі дітей, які приймали Урсофальк®. Висновки. Застосування урсодезоксихолевої кислоти (УДХК) патогенетично обґрунтоване для корекції функціональних, метаболічних порушень при біліарній патології та коморбідних станах, що підтверджують результати спостереження. При призначенні Урсофальку® в комплексній терапії захворювань жовчовивідної системи у дітей відзначається швидка регресія і купіювання клінічних симптомів, нормалізація лабораторно-інструментальних показників. Урсофальк® є референтним препаратом УДХК. Наявність офіцінальної форми препарату Урсофальк® у спеціальній лікарській формі для дітей у вигляді суспензії дозволяє застосовувати УДХК в дитячому віці, починаючи з перших днів життя.

Currently, there is an increase in the number of children who have multiple connected or “independent” pathological conditions, hospitalized to General hospitals with severe pain. It significantly worsens the disease course and complicates differential diagnosis in these patients, requires a deeper treatment approach. Thus, it requires attention and discussion and is urgent to cover the concept of comorbidity, combined with pain syndrome in Pediatrics. In this article is carried out the analysis of comorbid pathology in surgery from the point of view of the children’s anaesthetist. There were allocated comorbidities that are commonly encountered in daily practice and are of danger in surgical practice. We have analyzed analgesia for obesity, blood diseases, congenital heart defects, concomitant respiratory diseases – during surgery and in the postoperative period. To improve the efficiency of medical care for these patients it is important to develop an algorithm of physician's actions in the most common comorbid conditions. It is concluded that there is a need for additional studies for further clarifying the optimal management of pain and the effect of pain in case of comorbidities.

Ergospirometry is used to assess the perioperative prognosis in patients of different age groups, and traditionally, the indicators recorded on the peak of the exercise are evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes. A retrospective analysis of clinical and anamnestic data and ergospirometry parameters was performed in 100 patients (mean age (68,0 ± 2.6) year) who underwent planned lobectomy for stage II lung cancer. The following ergospirometry indicators were prognostically significant in relation to the risk of perioperative complications: the level of oxygen consumption and energy consumption at all stages of ergospirometry, starting from the adaptation stage; the dynamics of a decrease in cardiac output in the first minutes of exercise; the level of the anaerobic threshold; index of respiratory reserve at all stages of the study. BACKGROUND. The ergospirometry technique is used to assess exercise tolerance, differential diagnosis of shortness of breath, detection of previously unverified pathology of the cardiovascular and respiratory systems, assessment of the patient's preoperative status and rehabilitation measures. The presence of frailty and associated geriatric syndromes is considered an unfavorable prognostic factor, but the degree of their influence requires clarification. At the same time, it is necessary to take into account that adaptive reserves and, as a result, the ability to maintain homeostasis under the influence of a stressful factor are individual. In this regard, along with the presence of frailty syndrome, age-related viability must be taken into account. The value of ergospirometry for older people lies in the simultaneous assessment of a large number of parameters of the cardiorespiratory link and the metabolic profile under standardized load conditions. To determine the perioperative prognosis, parameters such as the level of oxygen consumption at the peak of exercise and at the anaerobic threshold, and the ventilation carbon dioxide equivalent are traditionally evaluated. Achieving peak values during the study may be difficult for people over 60 years old with comorbid pathology, and therefore it is important to study the dynamics of the subthreshold values recorded during stress testing and the dynamics of their changes. OBJECTIVE . Identification of the features of physiological reactions during cardiorespiratory stress in elderly people. MATERIALS AND METHODS. A retrospective analysis of clinical and anamnestic data and ergospirometry indicators of patients examined at the oncological department No. 4 (thoracic department) of St. Petersburg A.P. Pavlov First State Medical University was carried out. The criteria for inclusion in the study were: elderly age, the availability of comprehensive geriatric assessment data, the possibility of performing ergospirometry on a bicycle ergometer according to a standardized ramp exercise protocol, the absence of absolute contraindications to performing exercise testing, and the availability of voluntary informed consent to conduct the study. A total of 100 people were included in the study, the average age was (68.0 ± 2.6) year (84 men, 16 women). All patients were admitted to the department as planned due to the presence of stage II lung cancer in order to perform a planned lobectomy operation. An assessment of the presence of chronic somatic pathology, a comprehensive geriatric assessment, preoperative ergospirometry, and an analysis of the features of the perioperative period were performed. RESULTS. Frailty syndrome was detected in 39 % of patients, and prefrailty was observed in 29 % of the subjects. All patients had hypertension, 28% had ischemic heart disease, and 64 % had COPD. Patients with frailty syndrome showed lower values characterizing the level of oxygen consumption (p = 0.02) and energy consumption (p = 0.05) at all stages of ergospirometry, starting from the stage of adaptation (pedaling without load) compared with patients without frailty. In patients with frailty and prefrailty, there was a decrease in cardiac output by 15–25 % at the initial stage of the study (in the first minutes of exercise), more pronounced in the presence of frailty, which did not correlate with clinical and anamnestic data on the presence of coronary artery disease or clinically significant chronic heart failure. There was also an earlier achievement of the anaerobic threshold in patients with frailty syndrome with patients with prefrailty (p = 0.02) and patients without these geriatric syndromes (p = 0.0006). The load level to achieve the anaerobic threshold was (42.5 ± 4.6) W, (56.2 ± 3.4) W and (62.3 ± 2.9) W, respectively. Nonfatal complications associated with surgery were reported in 14 % of patients, and no deaths were observed. The analysis of ergospirometry results revealed a statistically significant increase in the level of the respiratory reserve index at each stage of the study in all patients with perioperative complications (sensitivity of this parameter was 66.7–91.7 %, specificity was 64.2–88.0 %, depending on the stage of exercise). CONCLUSION. The indicators recorded at the initial stages of ergospirometry may have significant prognostic value for assessing the adaptive potential of the body of elderly patients.

This article is devoted to the comorbidity of diseases of the digestive tract and respiratory system in children. Comorbidity (polymorbidity) in the pathology of the gastrointestinal tract is widely described in modern scientific literature, however, the relationship between the digestive and respiratory systems seems to be less studied.The purpose of the study was to analyze the endoscopic signs of refl ux pathology of the digestive tract in children with a comorbid condition — GERD and respiratory diseases occurring with broncho-o bstructive syndrome (BOS).Materials and methods. An in-depth examination of 180 children from 6 to 16 years old with comorbid pathology (respiratory diseases with BOS and GERD) was carried out. Performed: X-ray examination, spirometry, intracavitary pH-metry, EFGDS and ultrasound of the gastrointestinal tract. To study the morphological features of the esophageal mucosa in this comorbidity, biopsies were examined 1 cm above the Z-line; at the same time, a biopsy of the mucosa of the antrum of the prepyloric part of the stomach was performed.Results. Respiratory diseases with biofeedback in the examined groups of patients were most often (43.9%) combined with GERD at the age of 12–14 years. The predominance of endoscopically positive grade 1 GERD is typical for patients with broncho- obstructive syndrome caused by moderate and severe persistent BA, acute and prolonged pneumonia, and recurrent bronchitis. Infl ammatory diseases of the digestive system (chronic gastritis, chronic gastroduodenitis) in BA were detected in 40.6% of patients, in pneumonia — in 45.7%, in recurrent bronchitis — in 33.3% of patients. Based on the data of a general morphological study of biopsy specimens, regardless of age and type of bronchopulmonary pathology, two variants of infl ammation were identifi ed, which are more common than others — with a predominance of dystrophic changes and with a predominance of infl ammation itself, which largely depended on the duration of the disease. In patients suff ering from both BA and pneumonia with biofeedback, morphological changes in the esophageal mucosa corresponded to the catarrhal nature of the infl ammation.

The aim. To study the features of the clinical course of a new coronavirus infection in patients infected with HIV.Materials and methods. The study included patients with HIV infection who received inpatient care for a new coronavirus infection (n=118). The diagnosis of U07.1 was made by detecting SARS-CoV-2 RNA. The diagnosis of U07.2 was made on the basis of epidemiological and clinical data in the presence of antibodies to SARS-CoV-2 in the blood.Results and discussion. The overall cohort of patients was dominated by women (55,9%), the average age of all co-infected patients was 37,5±2,78 years. The study was dominated by patients with a long history of HIV infection (66,1%), 43,2% received antiretroviral therapy (ART). The new coronavirus infection had a moderate course in 75,4% of patients. Severe form was recorded in 16,9% of patients. The mortality rate was 12,7%. The clinical picture of the new coronavirus infection upon admission was very variable due to comorbid pathology. The most frequently recorded symptoms upon admission were: increased body temperature (100%); weakness and increased fatigue (94,8%); cough (83,9%); shortness of breath (75,4%). Less frequently recorded: rhinorrhea (54,2%); sore throat (44,1%); gastrointestinal syndrome (21,2%); cerebral syndrome (17,8%); edematous-ascitic syndrome (13,5%); hepatolienal syndrome (13,5%); exanthema syndrome (10,2%). In 28,7% of patients, the number of CD4 lymphocytes was less than 200 cells/ml. The average level of CD4 lymphocytes was 321,3±43,6 cells/ml. The work revealed that as the degree of immunosuppression increased, there was a sharp increase in cases of severe forms of the new coronavirus infection, as well as an increase in deaths. The average HIV RNA level was 578 161,9±103 457,4 copecks/ml. A high HIV viral load (more than 100 000 cop/ml) was observed in 41,5% of cases, and only in this group of patients were severe forms of the new coronavirus infection recorded and, as a consequence, death. All observed patients had comorbid pathology in the form of opportunistic infections and/or concomitant diseases. The most frequently recorded opportunistic infections were: candidiasis (77,9%), cerebral toxoplasmosis (17,8%), Pneumocystis pneumonia (16,1%), tuberculosis (14,4%), central nervous system damage caused by the Epstein-Barr virus (10,2%), cytomegalovirus infection (6,78%), HIV-associated anemia (3,39%), cervical cancer (1,69%). Often opportunistic infections had a polyetiological cause. Of the concomitant diseases, bacterial pneumonia (66,9%), chronic viral hepatitis (40,7%), cardiovascular diseases (26,3%), diseases of the gastrointestinal tract (21,2%), and nervous system were most often recorded (5,93%), urinary system (5,08%) and cancer (5,03%). In 89,8% of coinfected patients, prolonged release of SARS-CoV-2 was observed, which affected the duration of antiviral therapy and the length of hospitalization.Conclusion. The new coronavirus infection and HIV infection are the intersection of two epidemics with the subsequent mutually aggravating effect of pathogens on each other. Among the co-infected patients, young people of working age, reproductive age (30–49 years) with a long history of HIV infection (66,1%) and not taking ART (56,3%) predominated. The new coronavirus infection in HIV-infected patients more often occurred in a moderate form (75,4%), pneumonia was recorded in 83,1%. A severe form of the new coronavirus infection was recorded in 16,9% of patients. The work shows that as the degree of immunosuppression increased, there was a sharp increase in the frequency of severe forms of the new coronavirus infection. In the general cohort of patients, comorbid pathology was recorded in the form of opportunistic infections and/or concomitant diseases. Often opportunistic infections had a polyetiological cause. Multimorbidity aggravated the condition of patients and largely increased the risk of an unfavorable outcome. Mortality in the group of coinfected patients was 12,7%.

Dementia patients often received one clinical diagnosis, yet most of these cases present multiple underlying pathologies. Bringing the transition from clinical‐based to biological‐based diagnosis holds promise with the diagnostic criteria proposed by the Alzheimer’s Association (AA) Revised Criteria for Diagnosis and Staging of Alzheimer’s Disease and the Neuronal Synuclein Disease Integrated Staging System (NSD‐ISS). This session aims to explore the practical implications of the AA revised criteria for diagnosing and designing clinical trials in Lewy body disease (LBD).The updated version of the AA criteria proposes 3 biomarker categories: core Alzheimer’s disease (AD) biomarkers, non‐specific biomarkers, and biomarkers for common non‐AD co‐pathologies, including synucleinopathy (asyn). Utilizing the seeding amplification assay (SAA) to detect asyn pathology expands the biomarker toolkit, historically dominated by AD biomarkers. Identifying asyn in vivo in dementia cases enables recognizing underlying LBD, potentially reducing oversight of LBD cases with concurrent AD, which are less likely to present core features (particularly females).The AA criteria emphasize the role of clinical judgment in cases with comorbid pathology, proposing a biomarker profile for characterization. Challenges in evaluating several biomarkers in the clinical setting may be addressed using biofluid biomarkers and a stepwise process guided by clinical judgment.Practical applications of these criteria include their role as inclusion/exclusion criteria and stratification of LBD clinical trials. Similarly, in AD clinical trials, this framework allows excluding patients with comorbid pathologies to achieve a homogeneous study population.The AA revised criteria, along with the NSD‐ISS, serve as starting points for hypothesis testing. Future directions involve updating these frameworks with a patient‐centered approach, engaging patients and caregivers to understand the implications of biological‐based diagnosis. Longitudinal studies analyzing multiple comorbid pathologic changes are essential for determining the timeline of each pathology’s development. Finally, it is envisioned the creation of a comprehensive system to stratify disease progression of neurodegenerative diseases by incorporating biomarkers, demographic, clinical, and genetic data.

Aim. To develop a non-invasive method for diagnosing reflux esophagitis in patients with comorbid pathology: HP associated chronic gastritis and atopic dermatitis. Materials and methods. Two groups of children were examined: 60 had AtD and HP+CG and 30 had HP+CG without At D. Risk factors were selected on the basis of clinical, anamnestic, laboratory, and instrumental data, a decision tree was created as well. Conclusion. The conducted research allowed us to develop a plausible non-invasive method for diagnosing reflux esophagitis in children with AtD and HP+CG. Every risk factor (female gender, complaints of bitterness in the mouth, heartburn, abdominal pain, increased fat mass according to impedanceometry and increased level of zonulin in feces) is estimated as 1 point; the sum of points 5 and more indicates the presence of reflux esophagitis with a probability of 94.1% (invention application № 2024139936 from 26.12.2024).

The PGE2, PGF2 alpha, PGI2, and TXB2 content in biopsies of healthy esophageal mucosa and inflamed mucosa and from subjects with chronic esophagitis was measured and statistically analyzed. No significant differences were found between the tissue concentrations of prostaglandins in the inflamed and the healthy mucosa, except for elevated PGI2 content in the inflamed esophageal mucosa in comparison to healthy mucosa. The prostaglandin content of jejunal mucosa was unchanged in jejunitis and in atrophy compared to findings in healthy subjects. Regression analysis revealed a significant negative correlation between the PGF2 alpha and PGI2 content in both inflamed esophageal and inflamed jejunal mucosa. In healthy mucosa, no correlation was found between the tissue concentrations of these two prostaglandins, either in the esophagus or in the jejunum. These results suggest the redistribution of cyclic endoperoxide metabolism under certain pathological conditions.

Background. Morphological changes in the esophageal mucosa depend on the duration of reflux esophagitis. In type I hiatal hernia (HH), morphological changes are pronounced, the transition of the pathologi­cal process from inflammation to metaplasia/dysplasia is observed, while in HH type II, changes in the esopha­geal mucosa are less significant. Another associated pathology is inflammation of the gastric mucosa, which affects the stages and duration of treatment. Purpose: to investigate histological and morphometric differences of the esophageal and gastric mucosa depending on the type of HH. Materials and methods. The study was conducted on biopsy material of the esophageal and gastric mucosa in patients with HH (n = 34) who were divided by its types: type I — axial HH (n = 24) and type II — paraesophageal HH (n = 10). To study the histological structure, biopsy sections 5–7 µm thick were cut using a rotary microtome РM60-EКA, and staining was carried out using the standard method with hematoxylin-eosin. To obtain morphometric data, the sections were photographed with a light microscope XSZ-21 (Ukraine) and measured using Image J.45S software (USA). Results. Morphological study has shown that the development of pathological changes in the esophageal mucosa on the background of HH type I was accompanied by an increase in the height of the basal layer in 62.5 % of cases, an increase in the height of the papillae in 66.7 %, an expansion of the intercellular space in 83.3 %, the presence of eosinophils in the infiltrate in 20.8 %, lympho-plasmacytic inflammatory infiltration in 75.0 % (with HH type II, in 70.0 %), ballooning degeneration — in 33.3 % of cases (with HH type II, in 50.0 % of cases). Barrett’s esophagus was observed in 23.5 % of patients with HH type I: 14.7 % had intestinal metaplasia of the small- and large-intestine type, and 8.8 % had high-grade dysplasia. In HH type I, chronic non-atrophic gastritis (CNG) was diagnosed in 66.7 % of cases and chronic atrophic gastritis (CAG) — in 33.3 %, whereas in HH type II, CNG was diagnosed in all cases. According to morphometric studies of the gastric mucosa in case of CAG and CNG against the background of HH type I, a significant difference was found in the depth of the pits (p < 0.05), the length of fundic glands (p < 0.05), the height of the surface epithelium (p < 0.05) and the foveolar epithelium (p < 0.05). Significant changes between HH type I and type II were found regarding the thickness of the gastric mucosa (p < 0.05). The highest number of cells of the inflammatory infiltrate of the gastric CO was observed in CAG against the background of type I HH (p < 0.05). Conclusions. HH is accompanied by the development of esophagitis, the histological examination of which revealed an increase in the height of the papillae, basal layer, expansion of the intercellular space, ballooning degeneration, lymphocytic-neutrophilic and eosinophilic infiltration of the esophageal mucosa. The height of the basal layer in HH type I exceeds the norm morphometrically by 86.9 % (p < 0.01), in HH type II — by 68.8 % (p < 0.01), and the height of the papillae — by 56.7 and 46.6 %, respectively (p < 0.01). In HH type I, 23.5 % of patients were histologically diagnosed with Barrett’s esophagus. In HH type I, CNG was diagnosed in 66.7 % of cases, CAG — in 33.3 % of cases, and in HH type II, all patients had CNG.

The aim: To evaluate the pathomorphological features of the esophageal mucous membrane in young people with GERD and autoimmune thyroiditis. Materials and methods: 120 patients with GERD and AIT and 45 people with isolated GERD matched for age, gender and social status were examined. Esophagogastroduodenoscopy, histological study and comparative morphometry of the esophageal mucosa were performed. Results: The frequency of erosive GERD in the examined groups of patients did not statistically differ. At the same time, integral analysis of the structure of erosive forms of GERD revealed statistically significant redistribution of grades of esophagitis towards its enhancement in patients with comorbid pathology. The histological study showed that in patients with GERD and AIT all the morphometric parameters studied had a significantly more severe course and exceeded similar indicators of the group with isolated GERD: epithelium total thickness, epithelium basal layer thickness, connective tissue papillae height, intercellular space. The analysis of morphological changes frequency showed that epithelium basal layer hyperplasia, dystrophic changes and epithelial edema, elongation of papillae and dilation of intercellular space were significantly more frequent in the group with comorbid pathology. Conclusions: GERD and euthyroid AIT comorbidity in the student population is accompanied by a statistically significant redistribution of esophagitis grades towards its aggravation. The presence of concomitant euthyroid AIT in patients with non-erosive GERD leads to statistically more pronounced disorganization of esophageal mucosal epithelium.

To obtain biochemical evidence that Barrett's esophagus (BE) is the precursor of most adenocarcinomas (Adc) of the esophagus and cardia. Based on morphologic data, BE was previously proposed as the precursor of most Adc of the esophagus. This hypothesis would receive strong support if biochemical evidence were found to demonstrate a pattern common to BE and Adc of the esophagus and cardia. We studied the presence of intestinal-type proteins sucrase-isomaltase (SI) and crypt Cell Antigen (CCAg) in BE, Barrett's Adc, and esophageal-cardial Adc without BE. In each case specimens were collected from normal esophagus, stomach, tumor, and BE mucosa when present. To study related conditions, five specimens of peptic esophagitis and of squamous cell carcinoma were also analyzed. An indirect immunofluorescence technique was employed and sections were analyzed with laser confocal microscopy imaging. Most Barrett's mucosa specimens stained positively for SI (93%) and CCAg (89%). These proteins were detected in BE independently of the type of metaplasia, the coexistence of dysplasia, or the presence of associated Adc. SI and CCAg were present in 25 (96%) and 24 (92%) of the cases of Adc respectively. No statistical difference was detected in SI and CCAg expression between Adc samples with and without BE, between BE and Adc samples with or without BE, and between tumors located in the esophagus versus the cardia. No staining for these proteins was detected in stomach or esophageal mucosa, in submucosal glands of the esophagus, in peptic esophagitis or squamous cell carcinoma. These data show that BE and Adc of the esophagus and cardia have a similar phenotype and support the hypothesis that most of these tumors probably originate from preexisting BE.

The microscopic assessment of squamous epithelium lesions in gastro-oesophageal reflux disease (GERD) is subjective. The Ki67 nuclear antigen expressed by proliferating cells provides an objective measure of regeneration in the squamous epithelium. To evaluate Ki67 expression in GERD patients and controls, in comparison with histological lesions, pH-metry and endoscopic data. Eighty-seven patients with GERD symptoms and 20 symptom-free controls underwent endoscopy and 24-h pH monitoring. Oesophageal biopsies (4 cm, 2 cm and Z-line) were stained with Ki67/MIB-1 antibodies; the Ki67-positive nuclear area was assessed with an image analysis system and expressed as percentage of the whole epithelial area (Ki67-%). Ki67-% was significantly higher in 32 patients with erosive oesophagitis, 44 endoscopy-negative GERD and 11 patients with functional heartburn than in controls (P = 0.0001). Both controls and patients showed a progressive increase in Ki67-% from 4 cm to the Z-line (P < 0.0001). Ki67-% showed a significant correlation with other conventional histological lesions (P ranged between 0.0151 and <0.0001). Ki67 evaluation provides quantitative and objective data on squamous epithelium proliferative activity. This marker can be applied in the distinction of endoscopy-negative GERD from healthy controls.