ACTUAL ISSUES OF THE DIAGNOSTICS OF GASTROESOPHAGEAL REFLUX DISEASE WITH COMORBIDITY IN GENERAL PRACTICE
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i2.8683Keywords:
multicanal intraluminal esophageal impedance-pH-monitoring, esophagogastro-pH-monitoring, gastroesophageal reflux disease, obesity, arterial hypertension, functional dyspepsia. Отримано 12.02.2018Abstract
A key risk factor for GERD is obesity today. Obesity is a recognized risk factor for essential hypertension (AG), and diabetes mellitus (DM), and primary osteoarthritis, and COPD.
Material and Methods. In the clinic-diagnostic gastroenterological laboratory of VNMU named by M. Pyrohov was examined for patients with obesity and GERD with hyperleptinemia. Using the method of express-gastro-pH indication, pH parameters were studied in two groups of patients: obese and GERD patients, and patients with GERD with normal body mass. There has been a tendency towards greater HCl secretion in obese and GERD patients.
In a study conducted by us in patients with GERD in conjunction with hypertension, we tried to find out the features of lower esophageal sphincter motor disorders in these two diseases. To do this we conducted a 3-hour, 3-channel esophago-gastro-pH-monitoring. Patients with GERD with and without hypertension had the same amount of acid and all reflux, however, patients with concomitant hypertension had longer longest refluxes, and overall, acid exposure tended to lengthen (p> 0.05).
According to the research conducted by us in the form of opportunistic screening in the first stage (1431 adults), followed by instrumental and laboratory examination, it was found that 69.72 % of GERD patients (343 persons) had symptoms of gastric dyspepsia. Conducting a nonlinear regression analysis of the influence of risk factors showed that obesity is a powerful factor adjusting to pathological gastroesophageal reflux.
Conclusions. The combination of GERD with gastric dyspepsia (including FD), hypertension and overweight is common and is found in 47.3 %, 45.45 % and 63.86 % of the examined patients respectively. In the case of a combination of these ailments, it is an obvious comorbidity. Excessive body mass is the main factor of comorbidity of GERD with arterial hypertension, causing more intense reflux, which affects the increase of acid exposure and propensity to prolonged reflux. An additional effect may be the tendency of patients with arterial hypertension to excessive acidity of the stomach.
References
Hunt, R., Armstrong, D., Katelaris, P. (2017). World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease. J. Clin. Gastroenterol., 51 (6), 467-478.
Vakil van Zanten, N., Kahrilas, P., & Dent, J. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am. J. Gastroenterol., 101, 1900-1920.
Camilleri, M., Malhi, H., & Acosta, A. (2017). Gastrointestinal complications of obesity. Gastroenterology, 152 (7), 1656-1670.
El-Serag, H.B., Ergun, G.A., & Pandolfino, J. (2007). Obesity increases oesophageal acid exposure. Gut., 56, 749-755.
Akyüz, F., Uyanıkoglu, A., & Ermis, F. (2015). Gastroesophageal reflux in asymptomatic obese subjects: An esophageal impedance-pH study. World J. Gastroenterol., 21 (10), 3030-3034.
Chernobroviy, V., Melaschenko, S., & Ksenchyn, O. (2015). Studying the influence of obesity on the motility of the lower esophageal sphincter in patients with gastroesophageal reflux disease and functional dyspepsia, using multichannel intraluminal impedance-pH-monitoring. Neurogastroenterology & Motility, 27 (2), 49.
Nian, Y.Y., Feng, Ch., & Jing, C. (2015). Reflux characteristics of 113 GERD patients with abnormal 24-h multichannel intraluminal impedance-pH tests. J. Zhejiang Univ-Sci. B. (Biomed. & Biotechnol.), 16 (9), 805-810.
Abdelkader, N.A., Montasser, I.F., Bioumy, E.E., & Saad, W.E. (2015). Impact of anthropometric measures and serum leptin on severity of gastroesophageal reflux disease. Dis. Esophagus, 28 (7), 691-698.
Anggiansah, R., Sweis, R., & Anggiansahetal, A. (2013). The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro-oesophageal reflux disease. Aliment. Pharmacol. Ther., 37, 555-563.
Aslam, M., Slaughter, J. C., & Metal, G. (2012). Nonlinear relationship between body mass index and esophageal acid exposure in the extraesophageal manifestations of reflux. Clin. Gastroenterol.Hepatol., 10 (8), 874-878.
Chang, P., & Friedenberg, F. (2014). Obesity & GERD. Gastroenterol. Clin. North Am., 43 (1), 161-173.
Emerenziani, S., Rescio, M.P., & Guarino, M.P.L. (2013). Gastro-esophageal reflux disease and obesity, where is the link? World J. Gastroenterol., 19 (39), 6536-6539.
Jung, H.S., Choi, M.G., & Baeg, M.K. (2013). Obesity is associated with increasing esophageal acid exposure in Korean patients with gastroesophageal reflux disease symptoms. J. Neurogastroenterol. Motil., 19 (3).
Livzan, M.A., Lapteva, I.V., & Krolevets, T.S. (2015). Gastroezofagealnaya reflyuksnaya bolezn u lits s ozhireniyem i leptinorezistentnost [Gastroesophageal reflux disease in obese persons and leptin resistance]. Eksperimentalnaya i klinicheskaya gastroyenterologiya – Experimental and Clinical Gastroenterology, 115 (3), 11-16 [in Russian].
Livzan, M.A., Lapteva, I.V., & Krolevets, T.S. (2016). Osobennosti techeniya gastroezofagealnoy reflyuksnoy bolezni, assotsiirovannoy s ozhireniyem i izbytochnoy massoy tela [Features of the course of gastroesophageal reflux disease associated with obesity and overweight]. Terapevticheskiy arkhiv – Therapeutic Archive, 88 (2), 21-27.
Burgerhart, J.S., van de Meeberg, P.C., & Siersema, P.D. (2014). Nocturnal and daytime esophageal acid exposure in normal-weight, overweight, and obese patients with reflux symptoms. Eur. J. Gastroenterol. Hepatol., 26 (1), 6-10.
Park, S.K., Lee, T., & Yang, H.J. (2016). Weight loss and waist reduction is associated with improvement in gastroesophageal disease reflux symptoms: A longitudinal study of 15 295 subjects undergoing health checkups. Neurogastroenterol. Motil.
Doulami, G., Triantafyllou, S., & Natoudi, M. (2016). Normal values of 24H multichannel intraluminal impedance pH-metry in a Greek obese population based on Montreal definition of Gerd. Obes Surg., 26 (1), 126-131.
Chernobrovy, V., Melashchenko, S., & Ksenchyn, O. (2017). GERD: clinical solutions of problems in general practice. Wiadomosci Lekarskie, 2, 327-330.
Melashchenko, S.H., Chernobrovyi, V.M., & Kenschin, O.O. (2015). Diahnostychni mozhlyvosti 200-khvylynnoho postprandialnoho multykanalnoho intraliuminalnoho impedans-rN-monitorynhu stravokhodu porivniano z dobovym variantom [Diagnostic possibilities of 200-minute postprandial multicanal intraluminal impedance-pH monitoring of the esophagus compared to the daily option]. Hastroenterolohiia – Gastroenterology, 2 (56), 5-11 [in Ukrainian].
Lee, K.J., Kim, J.H., & Cho, S.W. (2006). Prevalence of ineffective esophageal motility and its relevance to symptoms and esophageal acid exposure in korean patients referred for foregut symptoms. Digestion, 73 (2-3), 171-177.
Chen, C.L., & Orr, W.C. (2006). Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis. Scand. J. Gastroenterol., 41 (9), 1001-1006.
Kalil, G.Z., & Haynes, W.G. (2012). Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications. Hypertens. Res. Hypertens. Res., 35 (1), 4-16.
Vakil, N., Halling, K., Ohlsson, L., & Wernersson, B. (2013). Symptom overlap between postprandial distress and epigastric pain syndromes of the Rome III Dyspepsia Classification. American Journal of Gastroenterology, 108, 767-774.
Miwa, H., & Kusano, M. Evidence-based clinical practice guidelines for functional dyspepsia. J. of Gastroenterology, 50, 125-139.
