The role of ghrelin and leptin in the formation of morphological changes esophagus of patients with gastro-esophageal reflux disease against type 2 diabetes

Abstract

Type 2 diabetes mellitus (T2DM) is associated today with a non-infectious epidemic. Every year, the number of people suffering from this disease only increases. The comorbidity of pathology, namely gastroesophageal reflux disease (GERD) against the background of type 2 diabetes mellitus, is increasingly observed. Pathogenetic mechanisms of the progression of the latter in the combined course with type 2 DM are not sufficiently studied today, and data on the effect of adipokines on the morphological pattern of the esophagus in patients with type 2 DM are emerging.
 The aim of this study is to study changes in the esophageal mucosa depending on the concentration of ghrelin and leptin in patients with comorbid GERD on the background of type 2 diabetes.
 Materials and methods of the research. 120 patients were recruited for the study and divided into 3 groups and a control group. The 1st group – 60 patients with a combined course of GERD and type 2 DM, the 2nd group – 20 patients with GERD, and the 3rd group – 20 patients with isolated type 2 DM. The control group - 20 practically healthy people of the appropriate age.
 The levels of ghrelin and leptin were determined by enzyme-linked immunosorbent assay (ELISA) on a Labline-90 analyzer (Austria).
 Endoscopic examination of the upper parts of the gastrointestinal tract (GI) with targeted biopsy was performed with an esophagogastroduodenoscope with end optics "Olympus GIF Q 150-03" (manufactured by Olympus Europa SE & CO. KG, Japan).
 The degree of complexity and the presence of reflux esophagitis were determined according to the Los Angeles classification and grading system of esophagitis of the Japanese Society of Esophagitis (JSDE), modified in 1999 [1].
 Results. Correlation analysis of the relationship between ghrelin and leptin indicators showed a reliable, inverse, medium strength dependence (r = -0.5531; p<0.05). Reliable maximum values of ghrelin were found in patients with non-erosive form of GERD, and minimum values of ghrelin were recorded in patients with reflux esophagitis stage C. When studying leptin indicators depending on the degree of esophagitis, the following data were obtained: the maximum values of leptin were found in patients with reflux - stage B esophagitis, and minimal - in patients with a non-erosive form of GERD. Regarding the reliability of the obtained data on leptin concentration, we did not find statistically significant differences in the studied groups (p>0.05).
 Conclusions. According to the results of the conducted research, we can say that changes in the concentration of ghrelin have an important diagnostic value in the focus of GERD against the background of type 2 diabetes. Decreased ghrelin levels have been associated with erosive forms of GERD in the setting of type 2 diabetes, which can lead to a significant deterioration in the patient's lifestyle. According to the data obtained during the study on the influence of leptin levels on changes in the mucous membrane of the esophagus, it was found that morphological changes in the esophagus did not depend on the concentration of leptin in the studied groups