The possibilities of transabdominal sonographic diagnosis of liver and intestinal lesions in comorbid gastroesophageal reflux disease

Abstract

Introduction. The spread of gastroesophageal reflux disease (GERD), comorbid with non-alcoholic fatty liver disease, requires modification of methods for non-invasive diagnosis of liver steatosis and fibrosis and concomitant gastrointestinal syndromes. Aim. Substantiation of a modified complex outpatient transabdominal sonographic diagnosis of combined lesions of the liver and intestines in comorbid GERD. Materials and methods. 165 outpatients with GERD (mean age 40.4 ± 2.9 years) underwent clinical and laboratory examinations, ultrasound examination (UE) of the gastrointestinal tract (GIT), liver shear wave elastometry (SWE), esophagogastroduodenoscopy, colonoscopy (CS). Results and discussion. In patients with GERD, a pronounced transsyndromic comorbidity was observed. The degrees of steatosis and fibrosis of the liver according to SWE positively correlated with the biochemical indices APRI and FORNS. ST-index of liver steatosis was statistically significantly associated with the presence of esophagitis, bile sludge, gallbladder polyps and thickening of the colon wall according to ultrasound criteria, sigmoiditis according to CS. Steatosis on ultrasound was associated with male sex, increased waist circumference, lactase deficiency and deficiency of cholecalciferol in the blood, the presence of yeast-like fungi in feces. Liver fibrosis according to the FORNS index directly correlated with the volume of HE-reflux, duodenitis and intestinal damage according to the results of ultrasound, and according to the APRI index, it inversely correlated with the concentration of vitamin D3 in the blood. Fibrosis according to the ESP criteria directly correlated with the presence of hiatal hernia, bile sludge, and the volume of HE-refluxate according to ultrasound criteria; with lactase deficiency, as well as esophagitis and colitis on endoscopic signs. Conclusions. To identify steatosis and liver fibrosis, the SWE methodology can be considered priority, and serum panels of biomarkers – alternative. Ultrasound of the gastrointestinal tract and SWE allow you to identify the degree of steatosis and fibrosis of the liver, the pathology of the esophagus, colon and the biliary system.