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

Kharkiv Medical Academy of Postgraduate Education

Indicators of external respiration function in patients with gastroesophageal reflux disease with concomitant chronic obstructive pulmonary disease.

Introduction. In modern medicine, it is increasingly rare to find a disease that runs in isolation, without accompanying any pathology in one system or the adjacent one^1-2. Therefore, nowadays, the problem of comorbid pathology is one of the leading ones³. The most frequent diseases, which usually occur combined with other pathology, are gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD)⁴.

A particular problem is the pathogenesis of the combined course of GERD and COPD. Moreover, the question of which disease is primary and which develops on its background is still being studied^5-6. At the same time, many medications, which are used during the treatment of COPD have a negative effect on the esophageal mucosa and tone of esophageal sphincter^7-9.

Proceeding from it can be assumed that there is a reverse effect of drugs for the treatment of GERD on the regulation of the processes of bronchial tree tone, and accordingly on the parameters of the function of external respiration in patients with combined pathology of GERD and COPD¹⁰. Therefore, the study of the features of the mutual influence of pathogenetic and therapeutic processes in combined pathology has a scientific interest and practical importance¹¹.

The aim of the research is to study the feature of the function of external respiration in patients with GERD with combined COPD.

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 Department of Therapy, Rheumatology and Clinical Pharmacology of the Kharkov Medical Academy of Postgraduate Education. The GERD diagnosis was established in accordance with ICD-10, considering the Montreal Consensus 2006 and Gstaad guidelines for GERD treatment. To validate the GERD diagnosis, patients were subjected to endoscopy by fibergastroscope, intragastric pH monitoring and GERD questionnaire. The diagnosis of COPD was validated according to ICD-10, and considering recommendations of Global initiative for obstructive lung diseases (GOLD) 2016. External breathing function was defined using spirograph by standard methodics. During the spirography, pharmacological tests were performed with a short-acting bronchodilator to determine its influence on lung function. To avoid distortions of bronchodilation test results patients stopped using bronchodilators in accordance with the pharmacological properties of used drug.

Analyzing spirography data, it was found that patients of the first group had a more distinct decrease in the respiratory function as compared with those in the control group and patients with GERD without comorbidity. Index FEV1 averaged 63.82 ± 2.70% at a rate of 96.7 ± 3.2% and 73.25 ± 3.1% of GERD patients without comorbidity. Indicators FEV1 / FVC in patients of the first group was 62.48 ± 1.57% at a rate of 85.2 ± 2.3% and 71.51 ± 1.91% of GERD patients without comorbidity. Indicators MOS and MOS 25% to 50% of the first group patients amounted, on average, 38.24 ± 2.31 l / sec and 33.21 ± 2.42 l / sec, whereas with the second group of patients the figures were 47.25 ± 2.32 l /sec. and 41.38 ± 2.37 l/sec. at a rate of 97.7 ± 2.61 l/sec. and 83.5 ± 2.29 l / sec (Picture).

Picture. Indicators of external respiration function in GERD patients with concomitant COPD, without comorbidities and control group.

Conclusions. Patients with GERD with concomitant COPD indicators of respiratory function were significantly lower than indicators of the control group and GERD without comorbidity patients. This led to decreasing protection factors of esophagogastric junction. Patients with isolated GERD had higher levels of gastric pH. It meant that it led to the activation of aggression factors and also to decreasing indicators of external respiration function.

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