Semenova N.V., Oparin A.A., Khomenko L.A.

Kharkiv Medical Academy of Postgraduate Education

Department of Therapy, Rheumatology and Clinical Pharmacology

Features of psychosomatic disorders in patients with gastroesophageal reflux disease with concomitant chronic obstructive pulmonary disease of I-II degrees.

As known, gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD) are the most prevalent among the structure of diseases of the gastrointestinal tract from 20% to 60%, and of the respiratory organs from 10% to 25% respectively^1-2. Their prevalence in the Asian continent is up to 28%³, in America from 7.7% to 30%⁴, and in Western Europe from 3% to 16%⁵.

Psychosomatic disorders play an important role in the formation of GERD⁶ by regulating the motor and secretory function of the digestive tract, as well as in the formation of COPD⁷ by regulating the processes of the bronchial tree tone, the study of the features of their pathological implementation in case of comorbidity can be use in practice⁸.

The main goal of the research is to examine the role of psychosomatic disorders in the mechanism of formation of GERD with concomitant COPD.

Materials and methods of research Proceeding from the stated objective, we took two groups of patients. The first group of patients consisted of 40 people (18 women and 22 men) aged from 20 to 35, who were sick with nonerosive GERD with concomitant COPD of I-II degree. The second group included 45 patients (26 men and 19 women) aged from 19 to 33 years, who were sick with nonerosive form of GERD without comorbidity. The control group consisted of 20 almost healthy persons of the same age and sex. During the study, an examination of young patients with GERD was performed on clinical basis of the our department. The GERD diagnosis was established in accordance with ICD-10, considering the Montreal Consensus and Gstaad guidelines for GERD treatment. The diagnosis of COPD was validated according to ICD-10, and considering recommendations of Global initiative for obstructive lung diseases (GOLD) 2016.

The psychosomatic condition of patients was determined by Spielberg's questionnaire of personal and reactive anxiety, Beck depression questionnaire, Eysenck personality questionnaire, and Sheehan anxiety questionnaire. The results were processed by methods of variation statistics using PC software Statystyka. Data were presented in a conventional form of (M ± m), where M – the arithmetic average, and m – the error of arithmetic average. The results were considered statistically significant when the probability of error was less than 5% (p < 0.05).

Results. The research resulted in both groups having significant change of psychosomatic status compared with the individuals of the control group. Patients with GERD concomitant COPD had indicators of depression 35.7 ± 2.1 points and patients with GERD without comorbidity had 26.8 ± 1.9 points at norm or rate 8.1 ± 1.1 points. Simultaneously, the patients of the first group indicated reactive and personal anxiety values 39.7 ± 0.91 and 38.4 ± 1.05 points at norm or rate 22.7 ± 1.4 and 23.5 ± 1.3 points. At the same time, patients with GERD without comorbidity, indicated reactive and personal anxiety values 43.4 ± 0.85 and 45.8 ± 1.6 points respectively. Patients with GERD concomitant COPD had indicators of trouble 52.4 ± 2.8 points, patients with isolated GERD had 45.27 ± 2.7 points. The level of the trouble indicators in the control group was 19.5 ± 1.4 points (Table). It was thus registered that patients with GERD concomitant COPD revealed a significant increase in depression and anxiety level not only compared with the control group, but compared also with GERD patients without comorbidity.

Table. Indicators of psychosomatic status in GERD patients with concomitant COPD and without comorbidity.

Psychosomatic disorders	First group	Second group	Control group
Depression	35.7 ± 2.1	26.8 ± 1.9	8.1 ± 1.1
Reactive anxiety	39.7 ± 0.91	43.4 ± 0.85	22.7 ± 1.4
Personal anxiety	38.4 ± 1.05	45.8 ± 1.6	23.5 ± 1.3
Trouble	45.27 ± 2.7	52.4 ± 2.8	19,5±1,4

At the same time, patients with GERD without comorbidity indicators of reactive and personal anxiety were significantly higher compared not only with the indicators of the control group, but also compared with indicators of patients with GERD with concomitant COPD. The trouble level indicators were significantly higher inside the group of patients with isolated GERD comparing both with the indicators of the GERD patients group with concomitant COPD and with the control group. It was also found that among patients with GERD with concomitant COPD, the majority were introverts (57%), while in patients with GERD without comorbidity dominated extroverts (32%) and neurotics (49%).

It was detected that both groups under research had significant psychosomatic disorders, compared with the control group. GERD patients with concomitant COPD had depression indicators that were significantly higher (35,7 ± 2,1) compared with indicators of the control group (8.1 ± 1.1) and GERD patients without comorbidity (26.8 ± 1.9). Reactive and personal anxiety indicators of GERD patients without comorbidity were significantly higher (43.4 ± 0.85 and 45.8 ± 1.6) than the indicators of the control group (22.7 ± 1,4 and 23.5 ± 1.3) and the indicators of the GERD with concomitant COPD group (39.7 ± 0.91 and 38.4 ± 1.05). At the same time, indicators of trouble were significantly higher in group patients with isolated GERD (52.4 ± 2.8) than the indicators of the control group (19.5 ± 1.4) and the indicators of the group with the GERD concomitant COPD (45.27 ± 2.7).

Conclusions. Research results shows that GERD patients with concomitant COPD had psychosomatic disorders primarily at the expense of depression and trouble lead to a reduction of the protective properties of the esophagogastric junction. Patients with isolated GERD, psychosomatic disorders, first of all, due to increasing of reactive and personal anxiety, lead to the increased production of hydrochloric acid and thereby contributed to an increase of the aggression factor. Data obtained during research evidenced the role of psychosomatic disorders during the formation of both diseases: the main and concomitant and required differentiated treatment, aimed at patients of the first group to improve the protective properties, while in the second group of patients to reduce aggression factors.

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