Abstract
The article presents data on the role of pepsinogen-1 and -2 and bilirubin in the formation of gastroesophageal reflux disease (GERD) in patients with chronic obstructive pulmonary disease (COPD). Clinical, biochemical, immunological research methods were used in the work. The activity of pepsinogens 1 and 2 and bilirubin in saliva was determined in all patients with combined pathology. It has been established that the presence of concomitant GERD in patients is an independent aggravating factor for the function of external respiration. In patients with concomitant GERD, a significant increase in acute phase parameters in the serum, indicating active systemic inflammation. Increased activity of the cytokine IL-6 and IFNγ indicates the activation of the cellular immune system, with an unregulated immune response that supports chronic inflammation in the bronchi even in remission. Increased levels of IL-4 are compensatory in nature, as IL-4 inhibits the production of macrophages of proinflammatory cytokines, including IL-6. Detection of correlations between the concentration of total bilirubin in saliva with a decrease in external respiration, namely FVC, FEV-1, as well as the presence of shortness of breath allows us to consider bilirubin as a possible marker of reflux and respiratory inflammation in the bronchi, until obstruction. The positive correlation of pepsinogen-1 in saliva with an allergic history, and pepsinogen-2 in saliva with cough, shortness of breath and smoking, and a negative correlation of pepsinogen-1 with the value of FEV1 / FVC, allows to consider pepsinogen-1 and pepsinogen-2 as markers of non-acid reflux and respiratory inflammation with bronchoobstruction
Highlights
In the general structure of morbidity, a significant percentage of all diseases are respiratory diseases
The presence of gastroesophageal reflux disease (GERD) is associated with a deterioration in the quality of life in this cohort of patients, worsening of symptoms, deterioration of external respiration, which leads to more frequent exacerbations of chronic obstructive pulmonary disease (COPD) (Makarova et al 2019, Francis,2016)
The inclusion criteria in the study confirmed the patients with exacerbation of COPD stage 2 (GOLD II), age> 40 years, forced expiratory volume per 1 second (FEV1) was
Summary
In the general structure of morbidity, a significant percentage of all diseases are respiratory diseases. Their share is about 60% (Chorna et al.,2020) This is due to the increase in the number of non-specific lung diseases, and is noticeable in the growing number of patients with chronic obstructive pulmonary disease (COPD). The issue of comorbidity of chronic obstructive pulmonary disease with gastroesophageal reflux disease as an interdependent pathological condition is attracting increasing attention. These diseases are combined in 25 – 60% of cases (Shevchuk-Budz,2018, Lin et al 2019). The pathology of the pulmonary system, provoking cough, leads to changes into intrathoracic pressure and, to a decrease in the tone of the lower esophageal sphincter, which is one of the pathogenic factors in the formation of GERD (Katzka et al 2011, Aras et al, 2010)
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