Medicine/4. Therapy

Doctor of Medicine, M.D. Oparin A.A., Doctor of Medicine, M.D. Oparin A.G., Kudriavtsev A.A, Lavrova N.V.

Kharkiv medical Acalemy of postgraduate education

Features of an oxidizing stress at a gastroezofageal reflux disease with the accompanying arterial hypertension among young age persons.

The problem of comorbidity became more actual last years. If earlier we spoke about a comorbidity generally in relation to persons of an average and, especially, advanced age, now the problem given became actual for young age persons too. Among structures of a comorbidity of the gastroezofageal reflux disease (GERD) and the arterial hypertension (AH) has high rank. At the same time there are unresolved several vital issues. First, what disease is initial in that case and what is formed at its background. Secondly, the considerable part of preparations shown at treatment of AH is contraindicated in the presence of the accompanying GERD because they lead to relaxation of the lower oesophageal sphincter. Therefore studying of the general pathogenetic mechanisms of both diseases will promote development of pathogenetic therapy according to this pathology.

One of the universal mechanisms which play an important role in formation both GERD and AH, is the oxidizing stress. According to this the purpose of our research was studying of features and a role of an oxidizing stress at a gastroezofageal reflux disease with the accompanying arterial hypertension among young age persons.

For our research was created two groups of sick students and control group which significantly wasn't differ on gender and age. are created.

The first group includes 55 (43 men (78,2%) and 12 women (21,8%)), patients with GERD with existence of not erosive esophagitis and with the accompanying idiopathic hypertension І stages 1-2 severity. In this group there were 11 patients (20%) aged from 18 till 20 years, 25 (45%) – aged from 25 till 30 years, 19 (34,5%) – aged from 30 till 35 years.

Also the second group included patients with GERD with not erosive form of an esophagitis, but without the combined pathology. Among them men - 30 (78,9%), women – 8 (21,1%), aged from 18 till 20 years – 8 (21%), from 20 to 25 years – 17 (44,8%), from 30 to 35 years – 13 (34,2%) patients. The control group was made by 20 healthy people which health indicators conformed to literature data and were taken for norm.

The diagnosis of GERD was established according to ICD-10 and the Montreal consensus (2006). The diagnosis of arterial hypertension was established according to ICD-10.

The quality of Life (QL) was estimated by means of the unified questionnaire of SF-36 which included an assessment scale of physical health and was filled with the patient independently. Scale indicators: physical functioning (RF), physical functioning role (RP), intensity of pain (BR), the general health (YH), emotional functioning role (RF), viability (VT), mental health (MH) and social functioning (SF), varied from 0 to 100 points where 100 points – the level of full health.

For statistical processing and the analysis of results of this research the statistical software package Statistica 5,0 and parametrical and nonparametric methods of statistics was used. For a dependent variable average values and errors of averages (M+m) for each group, and also a significance value (p) of a difference between these groups were calculated. Correlation communication was defined by means of coefficient of correlation (r).

During research we stated appreciable depression of quality of life indicators among both groups patients, and in comparison with control group at all scales of a questionnaire SF-36, the difference was statistically (p<0,001) reliable.

Also by us was established that patients with GERD with the combined arterial hypertension more evident statistically reliable (р<0,001) had a depression of protective properties of a mucous barrier at a gastroduodenal zone what lower testifies to (р<0,001) the level of SH groups (to 824,5±41,2 against 1076±40,1 mmol/l at patients without the combined pathology, at norm 1281,5±38,4), and also higher TBA-active level of products (to 14,7±0,71 mmol/l against 10,5±0,58 mmol/l among patients with GERD and without the combined pathology at norm of 3,8±0,29 mmol/l).

Between degree of expression of an oxidizing stress and depression of quality of life indicators was established accurate correlation. According to results of research, the changes taped by us demonstrate that one of releasers of formation of GERD and AH accompanying at it can be the oxidizing stress which leads on the one side to formation of a hypoxia both mucous an oesophagus, and a myocardium, and on another side – to rising of production of the hydrochloric acid, and on the third side to a vasospasm, i.e. to all those factors which play a role in a pathogenesis of concomitant pathology of GERD and AH.

Literature:

1. Bordin D.S., Kolesnikov S. V. Pathological bases of development of a gastroesophageal reflux disease. Diagnostics. Treatment / Messenger of family medicine. — 2013. — No. 3. — Page 30 — 34 (in Russian)

2. A gastroesophageal reflux disease / Under. L.B. Lazebnik edition. — M.: Medical practice, 2012. — 756 pages. (in Russian)

3. Ostroglyad A.V., Svintsitsky A.S., Vdovchenko In.І. Gastroesophageal reflux disease — Lviv, 2011. — 199 pages. (in Russian)

4. Bee-keepers V.D., Pozdnyakov O. Yu., Sukhanova T.K., etc. Pathology at a gastroesophageal reflux disease. — M, 2008. (in Russian)

5. Tuyev A.V., Kitayev E.A., Hlynov O. V. Features of a structural profile of arterial pressure at patients with the essential hypertension associated with acid diseases / I Grew. Cardiologic magazine. — 2010. — No. 10. — Page 37 — 41. (in Russian)

6. Fadeenko G. D., Gridnev A.E. Gastroesophageal reflux disease: oesophageal, extra oesophageal implications and a comorbidity / Under the editorship of A.N. Belovol. — To.: Health of Ukraine, 2014. — 376 pages. (in Russian)

7. Fadeenko G. D., Gridnev A. E. Gastroesophageal reflux disease and Helicobacter pylori//Modern gastroenterology. — 2014. — No. 1. — Page 93 — 96. (in Russian)

8. Ford A. C., Forman D., Bailey A. G. et al. The natural history of gastroesophageal reflux symptoms in the community and its effects on survival: longitudinal 10-year follow-up study//Aliment Pharmacol Ther. — 2013. — 37(3). — River 323 — 331.

9. G. D. Fadieienko, O. V. Izmailova Gastroesophageal reflux disease and coronary artery disease: current views and outstanding issues of the comorbidity//Suchasna гастроентерологія. — 2015. — No. 4(84). — Page 109 — 117. (in Russian)

10. Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: systematic review. J Neurogastroenterol Motil. — 2011. — Vol. 17. — P. 14 — 27.

11. Kaji M, Fujiwara Y, Shiba M, et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol 2010; 25:1151-1156.

12. Rubenstein J.H. Meta-analysis: association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux//Aliment Pharmacol Ther. — 2010. — 32(10). — P.1222 — 1227.