Effects of prolactin on the results of echocardiography and daily multichanel intraluminal impedans-pH-monitoring of the esophagus of patients with stable angina of effort and gastroesophageal reflux disease in the dynamics of treatment

Abstract

Objective — to establish the effect of complex therapy with the addition of meldonium on the results of echocardio­graphy, daily multichanel intraluminal impedans-pH-monitoring (DMII-pH-M) of the esophagus and serum prolactin level in patients with stable angina of tension (SAT) and gastroesophageal reflux disease (GERD) in the conditions of comorbidity.Materials and methods. The study included 88 patients with SAT I—II FC with comorbid endoscopically positive GERD, which was divided into 2 groups: in group 1 (43 persons) received treatment: antiaggregant (clopidogrel), β-blocker (bisoprolol), statin (rosuvastatin), prolonged Nitric Oxide Donors donor and nitroglycerin in angina pectoris, proton pump inhibitor (rabeprazole), prokinetic (domperidone) and antacid as needed. Patients in group 2 (45 subjects) received basic therapy with SAT and GERD, with the exception of prokinetics and NO donors, only nitroglycerin, if necessary, and additionally meldonium capsules 500 mg 2 g/d for 30 days. Echocardiography, DMII-pH-M of the esophagus were performed in all patients enrolled in the study and serum levels of prolactin were determined before and at day 30 of treatment.Results and discussion. Blood serum of patients with SAT with comorbid GERD remains high when prokinetic is received and adversely affects the overall contractility of the myocardium of the left ventricle, esophagitis regression, confirmation is correlated0 (r = –0.73) between the serum PL level and emission fraction of left ventricle; MNBI (mean nocturnal baseline impedance) (r = –0.71) in group 1 and (r = –0.7) in group 2. Against the background of correction of baseline therapy for SAT and GERD with cancellation of prokinetic intake and, with additional prescription of meldonium, we observed a statistically significant (р < 0.05) decrease in prolactin level (OR = 3.9609, 95 % CI 1.1761—13.3398, p < 0.0263), decrease in total number of refluxes per day (OR = 14.1, 95 % CI 4.9739—40.2144, p < 0.0001) (р < 0.05), increase of PSPW (postreflux swallow induced peristaltic wave) (OR = 3.9, 95 % CI 1.5845—9.4767, p < 0.003) (р < 0.05), MNBI (р < 0.05) and emission fraction of left ventricle (OR = 4.2, 95 % CI 1.4802—12.2029, p = 0.0072) (p < 0.05), compared with group 1.Conclusions. The correction of the basic therapy of the SAT and GERD with the prokinetics’ cancellation and the additional use of meldonium resulted in the decrease of serum prolactin levels, which closely correlated with the main indicators of echocardiography and DMII-pH-M, manifesting in an increase in the general contractility of the left myocardium ventricle and lower esophageal sphincter, increasing of the kinetic function of the esophagus and improving the regenerative capabilities of its mucous membrane.