Pathogenetic mechanisms of chronic obstructive pulmonary disease in comorbidity with gastroesophageal reflux disease

Abstract

The issue of comorbidity of chronic obstructive pulmonary disease with gastroesophageal reflux disease as mutually determined pathological conditions is attracting more and more attention. The aim of the research: to study the pathogenetic mechanisms of the combined course of chronic obstructive pulmonary disease with gastroesophageal reflux disease. Materials and methods: We formed 3 groups of patients: 1 group (n=60) – patients with COPD in combination with GERD, 2 group (n=42) – patients with COPD without signs of GERD, who were treated in the pulmonology department for exacerbation of the disease and group 3 (n=36) – patients with GERD who were treated on an outpatient basis. All patients underwent general clinical examinations and determination of IL-4, IL-6, IFNγ, IFNγ/IL-4, TNF-alpha, pepsinogen and bilirubin levels in saliva Results and Discussion. In patients with concomitant GERD, a significant increase in acute phase indicators in blood serum was found. An increase in the activity of IL-6 and IFNγ cytokines indicates the activation of the cellular link of immunity, with an unregulated immune response that supports chronic inflammation in the bronchi even during remission. The detection of correlations between the concentration of total bilirubin in saliva with a decrease in external respiratory function indicators, namely FJEL, FEV-1, as well as with the presence of shortness of breath allows considering bilirubin as one of the possible markers of reflux and respiratory inflammation in the bronchi, up to the development of obstruction . The positive correlation of pepsinogen-1 in saliva with an allergic history, and pepsinogen-2 with cough, shortness of breath, and smoking, and the negative correlation of pepsinogen-1 with the value of FEV1/FJEL, allows us to consider pepsinogen-1 and pepsinogen-2 as markers of non-acid reflux and respiratory inflammation. Conclusions: Determination of the content of pepsinogens 1 and 2 and bilirubin in saliva are non-invasive methods of detecting duodenogastroesophageal and laryngo-pharyngeal reflux in patients with existing GERD.