Form Of Gastroesophageal Reflux Disease Research Articles

Wake up to gastro-oesophageal reflux disease: The interplay between arousal and night-time reflux.

This review examines the temporal association between nocturnal gastro-oesophageal reflux and sleep-arousal cycles. Most nocturnal gastro-oesophageal reflux events occur during the awake cycle, and arousals precede most nocturnal gastro-oesophageal reflux events, indicating that arousal from sleep predisposes to nocturnal gastro-oesophageal reflux. This sheds light on the complex relationship between nocturnal gastro-oesophageal reflux and sleep, and has implications for managing nocturnal gastro-oesophageal reflux symptoms. The appearance of symptoms and the pathophysiology of nocturnal gastro-oesophageal reflux are influenced by sleep hygiene, sleep disturbances and the misalignment of circadian rhythms. Nocturnal gastro-oesophageal reflux and its related sleep disorders are prevalent and negatively impact the quality of life. There is conflicting evidence on whether nocturnal gastro-oesophageal reflux and sleep disturbances are causally linked, and whether sleep disturbances drive nocturnal gastro-oesophageal reflux. Poor sleep quality increases oesophageal hypersensitivity and overall acid exposure. The nocturnal gastro-oesophageal reflux is linked to the more severe forms of gastro-oesophageal reflux disease, especially with atypical/extra-oesophageal manifestations and complications of mucosal damage such as oesophagitis and stricture, Barret's oesophagus, and oesophageal adenocarcinoma. This review highlights the role of sleep problems in presenting nocturnal gastro-oesophageal reflux, and the potential benefits of treating sleep disturbances in enhancing patient care and quality of life.

Diagnosis of Columnar Metaplasia of the Esophageal Mucosa in Patients with Complicated Gastroesophageal Reflux Disease

Aim: to improve methods of diagnostics of esophageal mucosal forms of metaplasia and dysplasia in patients with complicated forms of gastroesophageal reflux disease (GERD) using multidisciplinary approach.Material and methods. Overall, 131 patients aged 18 to 84 years (mean age — 55.8 ± 16.7 years) with confirmed diagnosis of GERD complicated by development of metaplasia of mucosa of distal esophagus were included in retroand prospective study. At the prehospital stage the patients' complaints were estimated, anamnesis was taken. At the first stage of the diagnostic program all patients underwent detailed esophagogastroduodenoscopy in high resolution with white light. The region of esophageal mucosa with signs of metaplasia and determination of its prevalence was examined and evaluated with special attention. Ultrashort segment was revealed in 26 patients, short segment — in 47 patients, long segment of mucosal metaplasia was revealed in 58 patients. Then to reveal the signs of dysplasia we used specifying endoscopic methods: the structure of pitted and microvascular pattern was estimated in narrow spectral mode using BING classification system. If an irregular type of metaplasized epithelium structure was detected in the process of BING assessment, the areas suspicious for dysplasia were marked, followed by aim forceps biopsy from them. The next stage was staining of the metaplasized segment with 1.5 % ethanic acid solution — acetowhitening. PREDICT classification system was used to evaluate the stained mucosal sections with metaplasia. Targeted forceps biopsy was performed from the altered areas that most quickly lost their coloring. The final stage of the diagnostic program in all patients was a forceps biopsy of the mucosa of the metaplasic segment according to the Seattle protocol, which requires increasing the number of fragments as the metaplasic segment lengthens in a “blind” biopsy. The biopsy material was stained with hematoxylin and eosin, and periodic acid Schiff reaction was performed in combination with alcyanine blue according to the standard technique.Results. Endoscopic examination in white light and evaluation of metaplasia extent revealed ultrashort segment (<1 cm) in 26/131 (19.9 %) patients; short segment (1–3 cm) — in 47/131 (35.9 %); long segment (> 3 cm) — in 58/131 (44.3 %) patients. Among the diagnostic techniques used, the BING and PREDICT classifications had the highest accuracy, sensitivity, and specificity (accuracy — 88.9 and 95.3 %, sensitivity — 90.5 and 91.3 %, and specificity — 86.7 and 100 %, respectively), which significantly exceeded the Seattle protocol also used in this work. The results showed a low level of specificity (31.2 %), accuracy (54.5 %), and sensitivity (76.8 %) of the Seattle protocol. The use of BING and PREDICT classifications provided marking of compromised zones, allowing targeted histological sampling.Conclusions. The original study demonstrated the greatest sensitivity, specificity, and accuracy of PREDICT and BING methods in the diagnosis of metaplasia with signs of dysplasia in patients with complicated GERD. It is also important that the use of BING and PREDICT classification systems allows to reduce the number of biopsy samples in comparison with their unreasonably large number according to the Seattle protocol, thereby reducing mucosal and submucosal trauma of the esophagus and the risk of complications.

Заболевания верхних дыхательных путей как внепищеводные проявления гастроэзофагеальной рефлюксной болезни: современное состояние проблемы

Bronchial asthma, chronic cough, laryngitis, erosion of tooth enamel are attributed to extra esophageal manifestations of gastroesophageal reflux disease (GERD). This form of GERD is characterized by the difficulty of establishing the diagnosis and high frequency of ineffective therapy. The article describes the main endoscopic signs of damage to the esophagus and larynx, presents normal pH-impedance reflux monitoring and criteria for pathological reflux into the esophagus and the lower third of the pharynx, as well as the possibilities of additional diagnostic methods – esophageal manometry and pepsin test. Treatment of patients with extra esophageal manifestations of GERD is a difficult task; the results of randomized placebo-controlled studies are contradictory. At the same time, empirical therapy is most effective in patients whose extra esophageal symptoms are combined with typical ones

Тактика ведения рефрактерной формы гастроэзофагеальной рефлюксной болезни, развившейся у пациента после холецистэктомии: клиническое наблюдение

Тактика ведения рефрактерной формы гастроэзофагеальной рефлюксной болезни, развившейся у пациента после холецистэктомии: клиническое наблюдение

149. LOCAL INFLAMMATORY RESPONSE TO GASTROESOPHAGEAL REFLUX: ASSOCIATION OF GENE EXPRESSION OF INFLAMMATORY CYTOKINES WITH MULTICHANNEL INTRALUMINAL PH-IMPEDANCE DATA

Abstract Expression of inflammatory cytokines’ genes may take part in pathophysiology of different forms of gastroesophageal reflux disease (GERD). Aim: to explore the expression of inflammatory cytokines’ genes in esophageal mucosa in patients with erosive esophagitis and non-erosive forms of gastroesophageal reflux disease and its association with data of esophageal multichannel intraluminal pH-impedance measurements. This was a single-center prospective study. Esophageal mucosa samples were taken from lower part of the esophagus during endoscopy. Expression of IL-1β, IL-10, IL-18, TNFA, TLR4, GATA3, CD68, beta-2 macroglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. Multichannel intraluminal esophageal pH-impedance (MII-pH) studies performed to all the participants. Diagnosis of GERD was confirmed by the results of MII-pH data. Patients were allocated to erosive esophagitis (EE) or non-erosive GERD groups (NERD). Non-symptomatic subjects with normal endoscopy and MII-pH results served as a control. Spearman rank correlation was used to asses association of genes expression and results of MII-pH. Data of 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, p = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, p = 0.03) genes was found in EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 genes was lower (P < 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (R = 0.29), IL-18 (R = 0.31), TNFA (R = 0.35), GATA3 (R = 0.34), TLR4 (R = 0.29), CD68 (R = 0.37) genes. Mean esophageal рН correlated inversely with the expressions of IL-18, TNFA, GATA3, TLR4, CD68 genes. In patients with erosive esophagitis, local expression of interleukin 18 and GATA3 transcription factor genes was higher compared to subjects with non-erosive form of gastroesophageal reflux disease. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68 and B2M genes. Inverse correlation revealed between expression of IL-18, TNFA, GATA3, TLR4 CD68 genes and mean esophageal pH.

Local inflammatory response to gastroesophageal reflux: Association of gene expression of inflammatory cytokines with esophageal multichannel intraluminal impedance-pH data.

BACKGROUNDGene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease (GERD).AIMTo explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive forms of GERD (NERD) and its association with data of esophageal multichannel intraluminal impedance-pH (MII-pH) measurements.METHODSThis was a single-center prospective study. Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy. Expression of interleukin (IL)-1β, IL-10, IL-18, tumor necrosis factor α (TNFA), toll-like receptor 4 (TLR4), GATA binding protein 3 (GATA3), differentiation cluster 68 (CD68) and β-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. MII-pH measurements were performed on all the participants. Diagnosis of GERD was confirmed by the results of the MII-pH data. Based on the endoscopy, patients were allocated to the groups of EE and NERD. The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results. We used nonparametric statistics to compare the differences between the groups. Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.RESULTSData from 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, P = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, P = 0.03) was found in the EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 was lower (P < 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (Spearman’s rank r = 0.29), IL-18 (r = 0.31), TNFA (r = 0.35), GATA3 (r = 0.34), TLR4 (r = 0.29), and CD68 (r = 0.37). Mean esophageal рН correlated inversely with the expression of IL-18, TNFA, GATA3, TLR4, and CD68. No association of gene expression with the number of gastroesophageal refluxes was found.CONCLUSIONIn patients with EE, local expression of IL-18 and GATA3 was higher compared to subjects with NERD. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68, and β-2 microglobulin genes. Inverse correlation was revealed between expression of IL-18, TNFA, GATA3, TLR4, and CD68 and mean esophageal pH.

Endoscopic signs of gastroesophageal reflux disease with different hiatal hernias types

A hiatal hernia occurs in 83–94 % of patients with gastroesophageal reflux disease (GERD). Difficulties in diagnosing endoscopic signs of gastroesophageal reflux with combination of the most common hiatal hernia types remain relevant. Untimely and inaccurate endoscopic interpretation of these pathological changes significantly reduces the effectiveness of treatment. The aim of the research was to study the endoscopic signs of gastroesophageal reflux disease with the most common hiatal hernia type I and type III. Materials and methods. The examination results of 153 patients with GERD and the most common hiatal hernia type I and type III at the stage of preparation for antireflux surgical treatment were analyzed. The age was 54.5 ± 11.3, there were 48 (31.4 %) men, 105 (68.6 %) women. In Group I – 85 patients with GERD and type I hiatal hernia, in Group II – 68 patients with GERD and type III hiatal hernia. A complete preoperative examination necessarily included endoscopy with chromoendoscopy (mainly NBI or FICE), biopsy from suspicious foci of the gastric mucosa and the lower third of the esophagus followed by histological analysis. Statistical processing and mathematical analysis of the obtained results were performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). For comparative analysis the arithmetic mean and standard deviation were calculated and presented as M ± s. Differences between groups were assessed using the sub-module “Difference tests” in the module “Basic statistics and tables”. Differences at P &lt; 0.05 were considered statistically significant. Results. In both groups, non-erosive forms of gastroesophageal reflux disease prevailed: 57 (67.1 %) and 39 (57.4 %) patients respectively. Both in Groups I and II, among the erosive forms there were mainly LA A stages of esophagitis – 20 (23.5 %) and 17 (25.0 %). СLE signs of the esophageal mucosa prevailed in Group I – 16 (18.8 %) patients, in Group II – 5 (7.4 %) patients. The proximal edges of the gastric folds, which are visualized in all patients, were considered the reference point for the true esophageal-gastric junction. Complicated course of GERD was noted in both groups of patients. Conclusions. Endoscopic signs of GERD with hiatal hernia type I or type III have characteristic features, the severity of which manifestation does not depend on the type. A reliable indicator of the true esophageal-gastric junction location is the proximal edge of the gastric folds. Complicated course of GERD occurs in both groups: Barrett’s esophagus and Schatzki’s ring predominate in the Group I, strictures and ulcers of the esophagus – in the Group II.

Гастроэзофагеальная рефлюксная болезнь и коррекция ее проявлений у пациентов перед офтальмохирургическими вмешательствами

Purpose. Evaluation of the frequency of extraesophageal manifestations in the structure of gastroesophageal reflux disease (GERD) in patients admitted for ophthalmic surgery. Material and methods. The preoperative state of 76 patients with extraesophageal manifestations of GERD was analyzed. The assessment of the adequacy and effectiveness of drug therapy, algorithms for diagnosing extraesophageal manifestations of GERD is given, our own clinical case is presented to illustrate the complexity of diagnosing extraesophageal manifestations of GERD. Results. A group of 76 people with extraesophageal manifestations of GERD (21 %) out of 363 patients with GERD admitted for treatment in 2019 was studied. In 25 people (33 %), the extraesophageal form of GERD was not diagnosed before admission to the hospital. Of these, in 17 people GERD proceeded under the guise of cardiological pathology, in 8 people - under the guise of bronchopulmonary pathology. Conclusion. GERD occupies a leading position among diseases of the upper gastrointestinal tract (more than 30 %). About 21 % are atypical manifestations of GERD. Modern etiopathogenetic treatment of GERD makes it possible to effectively stop the symptoms of the disease, avoid polypharmacy, undesirable drug interactions and unreasonable refusal of planned surgical treatment for patients with ophthalmic diseases. Keywords: gastroesophageal reflux disease, extraesophageal manifestations, cardiological and bronchopulmonary “masks”, ophthalmic surgery.

Варіанти перебігу гастроезофагеальної рефлюксної хвороби залежно від виду рефлюксу

The purpose of the work was to study the clinical course of gastroesophageal reflux disease with acid and alkaline refluxes, to investigate the psychosomatic state, the features of endoscopic changes in the esophageal mucosa, changes in pH-measurement and gastric motility in patients with gastroesophageal reflux disease depending on the type of reflux. Materials and methods. A study of 60 patients with gastroesophageal reflux disease aged 24-65 years (mean age 44.5±5.3 years) was carried out. The main group consisted of 35 patients with gastroesophageal reflux disease with concomitant acid reflux, and the comparison group included 25 patients with verified alkaline reflux. Control group consisted of 20 practically healthy people. The groups were representative by age and sex. All patients underwent a comprehensive diagnostic program, which included a careful collection of life and medical history, questionnaires, clinical examinations, anthropometric studies, laboratory and instrumental studies. Results and discussion. Among the examined patients with gastroesophageal reflux disease with acid reflux, men predominated (60%). In contrast, the patients with alkaline reflux were dominated by female patients –76%. Most patients with alkaline reflux were overweight and had obesity of I and II degree. Тhe abdominal type of the obesity prevailed in the patients with alkaline reflux (64%). In the main group of the patients there was an increase in the number of acid reflux per day – 125±2.6, alkaline – 60±2.1 in the comparison group – 113±44.2 (p &lt;0.01). In the control group, weakly acidic reflux, which coincided with clinical manifestations, was registered less frequently – the average daily rate was 155±24.3. The average daily number of refluxes over 5 minutes in patients with acid reflux was 19.7±3.5, with alkaline – 16.8±3.3. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes in 14 (66.7%) people: reflux esophagitis grade A (38.1%), grade B (19.1%), grade C (9.5%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). Delayed gastric evacuation is more pronounced in patients with gastroesophageal reflux disease with alkaline reflux, which can be explained by slowing of motility of the stomach and the presence of duodenostasis. In the vast majority of patients in this group, complete evacuation of contrast from the stomach occurred in a period of 3 hours or more. This allows us to conclude that the violation of the contractile ability of the stomach is one of the main factors that slows gastric evacuation, increases intragastric pressure and contributes to the development of pathological dumping of gastric contents into the esophagus. Conclusion. The combined course of gastroesophageal reflux disease with acid and alkaline reflux is characterized by specific etiopathogenetic mechanisms of development, polymorphism of clinical symptoms, which worsens the psychosomatic state and quality of life of patients. In patients with gastroesophageal reflux disease with alkaline refluxes, concomitant lesions of the pancreato-biliary system were more often diagnosed. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes (66.7%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). A hiatal hernia was found in patients with acidic (22.9%) and alkaline reflux (28.1%). Insufficiency of the lower esophageal sphincter was observed in 40% of patients with alkaline reflux, in 34.2% of patients with acid reflux with normal body weight. In gastroesophageal reflux disease with acid reflux, persistent delay in gastric evacuation is caused by persistent pylorospasm

Gastroesophageal reflux disease in patients with morbid obesity

Aim. To study the prevalence and manifestations of gastroesophageal reflux disease (GERD) in patients with morbid obesity based on endoscopic, X-ray findings and the function of the lower esophageal sphincter. Materials and methods. The study involved 98 obese patients with a mean body mass index (BMI) of 55.6 ± 10.3 kg/m2. Of these, 30 were men (34.48 %) and 68 were women (65.52 %) aged 18–64 years, mean age – 42.3 ± 8.5. All the patients subsequently underwent fibroesophagogastroduodenoscopy, esophagomanometry, 24-hour esophageal pH monitoring, X-ray examination and bariatric surgery. The presence and severity of pathological gastroesophageal reflux were assessed using esophageal pH monitoring data based on the DeMeester score. In addition, the lower esophageal sphincter function was assessed, the number of refluxes and the duration of the longest reflux episode were calculated according to the data of esophagomanometry and 24-hour esophageal pH monitoring. Statistical data processing was carried out using the StatPlus 2007 software package. Results. In this paper, we studied the prevalence and manifestations of gastroesophageal reflux in 98 obese patients. The mean BMI was 55.6 ± 10.3 kg/m2, the maximum was 72 kg/m2. GERD was diagnosed in 37 (37.76 %) patients, including 8 (8.16 %) patients with a hiatal hernia. The erosive form prevailed in the GERD pattern – in 24 (24.48 %) patients. In 32 (32.65 %) examined patients, pathological reflux was diagnosed during the daytime, especially after eating. Conclusions. The study results indicate that 37.76 % of obese patients are diagnosed with GERD arising from anatomical features and function of the gastroesophageal junction with the predominance of erosive forms of GERD. The state of the gastroesophageal junction in obese patients should be considered when choosing the optimal bariatric or metabolic surgery.

Screening for laryngeal disease in patients with gastroesophageal reflux disease

To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD). 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy. The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases. Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.

Itopride in treatment of laryngopharyngeal symptoms of gastroesophageal reflux disease.

In everyday otolaryngological and gastroenterological practice, the diagnosis and treatment of extraesophageal forms of gastroesophageal reflux disease are often challenging. It is sometimes the case that treatment ordered by other specialists proves ineffective or even worsens the symptoms. There is no golden standard of diagnosis for otolaryngological forms of GERD, and currently used tools (gastroscopy, laryngoscopy, impedance and pH testing) have low sensitivity and specificity. After finishing a course of successful treatment, the patients often come back to our offices with the very same symptoms. In order to improve the efficacy of treatment, a prokinetic agent can be added to the standard proton pump inhibitor therapy.

Фактори ризику та можливості запобігання формуванню гастроезофагеальної рефлюксної хвороби в дітей шкільного віку

Актуальність. У статті наведені основні проблеми ранньої діагностики гастроезофагеальної рефлюксної хвороби (ГЕРХ) у дітей шкільного віку, що призводять до пізнього виявлення та початку лікування. Метою дослідження було визначення основних факторів ризику, що можуть зумовлювати розвиток захворювання, а також тригерів, які провокують розвиток ГЕРХ у дітей шкільного віку. Знання факторів ризику може допомогти в профілактиці формування ГЕРХ у дітей та при вчасній діагностиці та терапії зменшити тяжкість захворювання та покращити показники якості життя. Матеріали та методи. У відкритому дослідженні брали участь 98 дітей шкільного віку (31 дівчинка, 67 хлопців) віком від 6 до 18 років (середній вік становив 14,2 року). Діагностика гастроезофагеальної рефлюксної хвороби була проведена відповідно до Наказу МОЗ України від 29.01.2013 № 59 «Про затвердження уніфікованих клінічних протоколів медичної допомоги дітям із захворюваннями органів травлення». При комплексному обстеженні проведено визначення можливих факторів ризику, для чого було здійснено детальний збір анамнезу: визначали характер харчування дитини та регулярність прийому їжі, режим дня, наявність та інтенсивність фізичного навантаження, наявність хронічного стресу (психотравмуючих ситуацій), тривалість сну, наявність шкідливих звичок, хибних харчових звичок. З анамнезу життя також з’ясовували тривалість грудного вигодовування та початок введення прикорму. Фізикальне обстеження було спрямоване також на виявлення так званих симптомів тривоги red flags, що можуть свідчити про наявність ускладнень чи органічної патології. Результати. В обох вікових групах переважали хлопчики, окрім того, вірогідно більше серед хворих із ГЕРХ було дітей з 2-ї групи — віком 13–17 років. Раннє введення прикорму було виявлено в обох групах, як і раннє штучне/змішане вигодовування. Більше 85 % дітей мали ознаки вегетативної дисрегуляції та наявну супутню патологію верхніх відділів травного тракту. Цікавим є той факт, що в більшості обстежених індекс маси тіла відповідав нормі, тобто цей фактор ризику не мав вірогідного значення. Висновки. У результаті проведеного дослідження визначено основні фактори ризику, що сприяють формуванню ГЕРХ у дітей двох вікових груп: 6–12 років та 13–17 років, а також проаналізовано взаємозв’язок окремих факторів ризику з різними формами ГЕРХ. Оптимізація первинної скринінгової діагностики ГЕРХ може бути досягнена завдяки використанню на амбулаторному етапі надання медичної допомоги адаптованого дитячого опитувальника за типом GERDQ, що включає питання не лише з типових стравохідних клінічних симптомів, але й із позастравохідних та атипових симптомів ГЕРХ. Більшість факторів ризику та тригерних факторів модифіковані, отже, контроль за станом дітей на етапі надання первинної медичної допомоги, що знаходяться в групі ризику з формування ГЕРХ, своєчасна діагностика та корекція факторів ризику чи рефлюксних порушень, що виникають за наявності цих факторів, дозволять запобігти розвитку захворювання чи появі тяжкого перебігу, що підвищить якість життя пацієнта.

Роль біологічно активних речовин у формуванні гастроезофагеальної рефлюксної хвороби у хворих на цукровий діабет 2 типу

Актуальність. У наш час недостатньо вивчені фактори, що впливають на перебіг і клінічні прояви гастроезофагеальної рефлюксної хвороби (ГЕРХ) у хворих на цукровий діабет (ЦД) 2 типу. Мета. Дослідження особливостей зміни рівнів простагландинів (Pg) І2 та F2α у сироватці крові залежно від клінічного перебігу ГЕРХ у хворих на ЦД 2 типу. Матеріали та методи. Обстежено 82 хворих на ГЕРХ і ЦД 2 типу (основна — 1 група) і групу порівняння (85 хворих на ГЕРХ — 2 група). Обстеженим пацієнтам у сироватці крові проводили визначення PgF2α та 6-кето-простагландину F1α (простациклін крові — PgI2). Результати. Скарги щодо органів травлення, характерні для ГЕРХ, установлено у 61,0 % пацієнтів 1 групи; у 22,0 % хворих із поєднаною патологією виявлено отоларингологічну; у 17,1 % обстежених — кардіальну форму ГЕРХ. У хворих на поєднану патологію більш виражене підвищення концентрації PgI2 із позастравохідними проявами ГЕРХ, особливо при його отоларингологічній формі (в 4,1 раза порівняно з показниками контрольної групи), тоді як у хворих при кардіальній масці ГЕРХ його концентрація підвищена у 3,5 раза, а у хворих зі стравохідними проявами ГЕРХ і ЦД 2 типу — у 3,0 раза. У хворих на ГЕРХ аналогічні зміни встановлено у 2,4 раза (отоларингологічні прояви), у 2,2 раза (кардіологічні прояви) та у 1,6 раза (типові прояви ГЕРХ) частіше. Висновки. ГЕРХ при ЦД 2 типу часто проявляється позастравохідною симптоматикою (отоларингологічна, кардіологічна форми). Максимальне підвищення рівня простацикліну у сироватці крові встановлено у хворих із позастравохідними проявами ГЕРХ у поєднанні з ЦД 2 типу, особливо його отоларингологічної форми.

Особливості добового рН-моніторингу стравоходу залежно від клінічної форми гастроезофагеальної рефлюксної хвороби у хворих на цукровий діабет 2-го типу

Мета дослідження: визначити особливості добового рН-моніторингу стравоходу залежно від клінічної форми гастроезофагеальної рефлюксної хвороби у хворих на цукровий діабет (ЦД) 2-го типу. Матеріали та методи. Обстежені 82 хворі на ЦД 2-го типу з гастроезофагеальною рефлюксною хворобою. Всім хворим проведено добовий рН-моніторинг. Результати. Загальний відсоток часу, протягом якого рН у стравоході становив &lt; 4, майже в однаковому ступені перевищував такий показник у контрольній групі (31,7 ± 2,3 % у хворих зі стравохідною формою гастроезофагеальної рефлюксної хвороби та 32,7 ± 2,9 % у хворих із позастравохідною формою проти 4,5 ± 0,3 % у контрольній групі, р &lt; 0,01). Висновки. У хворих на ЦД 2-го типу зі стравохідною формою гастроезофагеальної рефлюксної хвороби при добовому рН-моніторингу рН &lt; 4 у стравоході частіше відмічається при вертикальному положенні, а у хворих із позастравохідною формою — при горизонтальному. У хворих на ЦД 2-го типу зі стравохідною формою гастроезофагеальної рефлюксної хвороби порушення стравохідного рН асоціюється з кандидозним езофагітом, тоді як у хворих із позастравохідною формою — із дуоденогастральним рефлюксом (r = 0,84; р &lt; 0,01; r = 0,71; р &lt; 0,05 відповідно).

Dental mask of gastroesophageal reflux disease

In clinical practice, there are patients for whom traditional methods of treatment do not allow getting rid of a dental disease. Dental mask of underlying pathology may be a potential cause of this. The aim of the study was to study the features of the clinical course of dental manifestations of gastroesophageal reflux disease. Methods. The study group included 45 patients aged 20 to 50 years with complaints of pathological changes in the oral cavity that did not stop during the last month. The survey included a survey and clinical examination. The GerdQ questionnaire was used to verify gastrointestinal disorders. Results. It was found that 85% of the surveyed complained of a burning sensation behind the breastbone, the ingress of acidic contents into the oral cavity. 100% of the surveyed presented dental complaints. At the same time, the frequency of dental complaints was significantly higher compared to the frequency of complaints of esophageal symptoms. According to the results of the GerdQ questionnaire, the average score among the subjects was 11.0, which corresponds to the presence of gastroesophageal reflux disease. According to the results of the dental examination, 87% of the examined patients had pathological elements on the oral mucosa, and the pathological elements of aphthous and herpetic stomatitis were found significantly more often in patients with an exacerbation of gastroesophageal reflux disease (p&lt;0.05). Desquamative glossitis was detected in 33% of the examined patients, benign migratory glossitis (“geographical” tongue) in 59% of patients, exfoliative cheilitis (dry form) in 70% of patients, angular cheilitis in 23% of patients. The pathology of hard dental tissues was represented by multiple carious lesions in 75% of patients and non-carious lesions in 53% of patients. Conclusions. Diseases of the oral mucosa and non-carious lesions accompany patients with gastrointestinal tract pathology in the form of gastroesophageal reflux disease.

Effects of morphological changes in the esophageal mucosa in gastroesophageal reflux disease on the indicators of the antioxidant system in students with autoimmune thyroiditis

Objective — to establish changes in indicators of the antioxidant defence system, taking into account the morphological form of the esophageal mucosa lesions in patients with gastroesophageal reflux disease (GERD), occurring against the background of autoimmune thyroiditis (AIT).&#x0D; Materials and methods. The study involved 120 students with GERD and AIT, aged 18 to 25 years; from them 93 (77.5 %) females and 27 (22.5 %) males. The disease duration did nit exceed 3 years. Fibrogastroduodenoscopic examination has shown an erosive form of gastroesophageal reflux disease in 34 patients (28.3 %) and non‑erosive form of the disease was in 86 cases (71.7 %). Indicators of the total antioxidant activity of glutathione peroxidase and mitochondrial manganese superoxide dismutase were examined.&#x0D; Results. A decrease in the total indicator of the total antioxidant activity was established, which was estimated as the failure of the first phase of the antioxidant defence system. At the same time, an increase in the activity of manganese superoxide dismutase and a decrease in the production of glutathione peroxidase were noted. The levels of total antioxidant activity and glutathione peroxidase correlated with morphological changes in the esophageal mucosa: the presence of the erosive form of the disease had a greater impact on the changes in these parameters.&#x0D; Conclusions. The combined course of gastroesophageal reflux disease and autoimmune thyroiditis in students was accompanied by a decrease in the indicators of total antioxidant activity and glutathione peroxidase and an increase in the activity of manganese superoxide dismutase. The presence of erosions in the esophageal mucosa had a greater impact on the changes in the parameters of total antioxidant activity and glutathione peroxidase.&#x0D;

Особливості перебігу патології шлунково-кишкового тракту у хворих на гастроезофагеальну рефлюксну хворобу на тлі гіпотиреозу

The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum

461 AMOUNTS OF FAT AND PROTEIN CONSUMPTION ARE HIGHER, BUT OF POLYUNSATURATED FATS LOWER IN CHILDREN WITH GERD COMPARED TO CONTROLS

Abstract In contrast to adults, characteristic features of diet in children with GERD are not widely studied. Still, they may play an important role in pathogenesis of the disease and are important from the viewpoint of possible non-pharmacological treatment. The aim of the study was to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease. Methods Based on symptom evaluation and esophageal pH-impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, oesophagitis, and z-score body mass index (BMI). Results Data of 219 children and adolescents were available for the final analysis. Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to z-score BMI. In contrast to nonerosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me [25%;75%]): 14.3 (11.07; 19.1) % vs 8.5 (6.71; 14.1) %, total fat 36.8 (12.5; 75.5) % versus 16.9 (10.1; 17.9) %, and less polyunsaturated fats −54.3 (−73.4; −47.7) % vs −45.6 (−56.2; −33.1) %, P &amp;lt; 0.05. Conclusion The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to z score BMI. Low dietary fibre consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to nonerosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in patients with GERD with erosive esophagitis.

An integrated approach to treatment of patients with complicated forms of gastroesophageal reflux disease

Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease.&#x0D; Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 48 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhibitors omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture.&#x0D; Results. The frequency of intraoperative [6.3% (95% CI 1.45.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.445.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.77.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.193.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.793.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attributable to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance.&#x0D; Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.