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12GHRELIN AND FEATURES OF THE COURSE OF GASTROESOPHAGEAL REFLUX DISEASE WITH COMORBID TYPE II DIABETES MELLITUS
Oparin O.
Doctor of Medical Sciences, Professor
Oparin A.
Doctor of Medical Sciences, Professor Kudriavtsev A.
Graduate student, Kharkiv Medical Academy of Postgraduate Education
Kharkiv, Ukraine
Abstract
The role of ghrelin in the mechanisms of the formation of the comorbid course of GERD and type 2 diabetes was studied.
Two groups of patients with GERD and type 2 diabetes of mild and moderate severity and isolated GERD were examined. It was found that in patients suffering from GERD with type 2 diabetes, normalization of carbohydrate metabolism was observed from the first days of treatment. In patients of both groups, the intensity of clinical manifestations of GERD decreased - heartburn, dyspeptic symptoms.
It was shown that in patients with GERD with type 2 diabetes there is a marked change in ghrelin level. A correlation between the severity, the features of the clinical picture, stomach pH and the change in ghrelin levels was revealed. The inclusion of actovegin in the treatment regimen for patients with GERD and GD contributes to a reduction in the period of exacerbation of diabetes and GERD while normalizing ghrelin, stomach pH and motor-secretory disorders.
Keywords: ghrelin, actovegin, gastroesophageal reflux disease, type 2 diabetes mellitus, motor-secretory accumulation, antioxidant defense.
Today, the pathology of the digestive system remains one of the most pressing problems of modern medicine. Scientists pay much attention to the biochemical and molecular mechanisms that underlie these pathologies. One of the most common diseases of the digestive system is gastroesophageal reflux disease. The prevalence of pathology reaches 25% among all adults, and there is also a pronounced tendency to its further growth with an annual growth rate of about 5%. [15.19].
The increasing relevance of this problem is associated with the clinical significance and widespread prevalence of the disease worldwide, which amounts to 40-60% in Eastern Europe, with esophagitis found in 45-80% of patients [1.12].
One of the most common concomitant GERD pathologies is diabetes mellitus [7-10]. Moreover, GERD is more common in type 2 diabetes compared with type 1 diabetes (31.1% compared to 19.6%), and decompensation of carbohydrate metabolism in the form of ketoacidosis contributes to this development. One of the features of the course of GERD in patients with diabetes is the slightly or asymptomatic nature of the clinical picture, which is caused by the formation of polyneuropathy, which leads to a decrease in pressure of the lower esophageal sphincter (hyperglycemia increases the time of "transitional relaxation"), a decrease in the amplitude and frequency of peristaltic waves, and an increase in asynchronous and ineffective waves of esophageal contractions, delayed gastric secretion. Considering that more than 75% of patients with type 2 diabetes are overweight, one should pay attention to the fact that this category of patients is prone to the development of frequent episodes of reflux in comparison with patients with normal body weight [3,6,13].
Type 2 diabetes mellitus significantly modifies the pathogenesis of GERD, its clinical course, and that in
turn affects the course of the pathogenesis and clinical picture of diabetes mellitus, which, in turn, is reflected in the treatment of both diseases [6].
The use of modern methods of complex diagnostics, the appointment of adequate and differentiated therapy significantly improves the prognosis of the clinical course of diseases, improves the quality of life of patients, which allows to solve the medical and social component of this problem [2,3].
Noteworthy is the fact that today a large number of issues related to the formation of this comorbid pathology remain not fully understood and not disclosed. This explains the lack of perfect diagnostic methods and therapeutic tactics for such patients, which requires further study.
One of the hormones, which in recent years has been given an important place in metabolic disorders, is ghrelin. He plays an important role in the pathogenesis and clinical course of this comorbid pathology. Changes in the level of this hormone along with oxidative stress are some of the triggers for the formation of GERD in combination with type 2 diabetes. Ghrelin also contributes to exacerbating the clinical symptoms of each disease [4,5].
It has been shown that ghrelin concentration decreases during various metabolic processes, including type 2 diabetes mellitus. This hormone plays an important role in the regulation of the functions of the organs of the gastrointestinal tract. The development of postprandial hyperglycemia is also affected by the fact that the concentration of ghrelin decreases, which leads to a slowdown in gastric emptying, which is one of the pathogenetic links in the development of GERD and type 2 diabetes. Ghrelin also plays a role in the metabolism of glucose and insulin, therefore, a change in its blood level negatively affects the glycemic profile of
patients, the clinical course and severity of the symptoms of type 2 diabetes [11,14].
All these facts worsen the quality of life indicators of patients with such a comorbid pathology, which leads to the formation of symptoms of anxiety, apathy, depression, as well as sleep disturbance and a change in patient appetite and satiety, which, in turn, aggravates the course of both GERD and Type 2 diabetes, so they require an integrated approach to the treatment of both pathologies.
All of the above confirms that many pathogenetic mechanisms of the formation of this comorbid pathology in one patient, including the role of oxidative stress and saturation hormone - ghrelin, which occupies an important place in the mechanisms of formation of both type 2 diabetes and GERD, to the end remains unstudied and requires further research.
The purpose of the work is to study the role of ghrelin in the mechanisms of the formation of the comorbid course of GERD with concomitant type 2 diabetes mellitus. Based on the goal, we have formulated the research objectives: 1. To study the features of ghrelin content in patients with isolated GERD and GERD with concomitant type 2 diabetes. 2. To study the correlation relationship between the level of ghrelin content, the severity of the course of GERD with concomitant type 2 diabetes. 3. To study the effect of ac-tovegin on the content of ghrelin, the clinical course of GERD with type 2 diabetes in young people.
Materials and methods
To obtain the results, we conducted a study of two groups of patients suffering from GERD with concomitant type 2 diabetes mellitus of mild and moderate severity and isolated GERD.
The first group included 24 patients - 11 men and 13 women aged 19-43 years (average age 37.2 ± 0.69 years), suffering from GERD with concomitant type 2 diabetes mellitus, who received standard therapy - metformin. The dose was calculated taking into account the level of glycemic profile. Also, treatment included omeprazole 20 mg 2 times a day and Actovegin 200 mg 2 times a day.
The second group included 23 patients with isolated GERD (13 men and 10 women) aged 18-41 years (mean age 35.7 ± 0.54 years). Patients received standard therapy - omeprazole 20 mg 2 times a day for 1 month and Actovegin 200 mg 2 times a day.
The control group included 20 healthy individuals of the same gender and age.Averages of 20 healthy individuals of the same age and gender were taken as norms.
The examination program included: determining the degree of compensation of carbohydrate metabolism by the level of blood glucose and glycated hemoglobin HbA1c by chromatographic method; ghrelin level was determined by enzyme immunoassay using a standard set of reagents (SOD1 ELISA SYSTEM manufactured by LSbio, USA);
Statistical processing of the obtained data was carried out using the Windows Statistica 6.0 program. Comparison of the indicators in the groups was carried out by the method of parametric (t - student criterion) statistics.
The relationship between the indicators in the groups was evaluated using the Pearson correlation analysis (r is the correlation coefficient). For all types of analysis of statistical significance, differences were considered at p <0.05.
Results and its discussion
In the study, we found that in patients suffering from GERD with concomitant type 2 diabetes, normalization of glycemic profile from the first days of the treatment was observed. In patients of both groups, the intensity of symptoms of GERD decreased - heartburn and the number of its episodes, the frequency and intensity of dyspeptic symptoms, in particular belching, decreased.
Moreover, in patients who received Actovegin additionally, the onset of expressed relief was shorter by 1-3 days, and averaged 5.3 ± 1.13, while in patients who were only on standard therapy, clinical remission occurred after 8.5 ± 1.25 days, which was statistically longer (p <0.5) than in patients of the first group. At the same time, we found that against the background of a 4-week course of treatment, the level of ghrelin increased in patients of both groups. In particular, in the group of patients with isolated GERD, ghrelin indicators increased from an average of 3.5 ng / ml to 4.7 ng / ml and almost came close to the control group (5.0 ng / ml) (p <0.05 )
GERD patients with concomitant diabetes mellitus also showed a tendency to increase ghrelin: 1.2 ng / ml before treatment and 4.5 ng / ml after treatment.
In patients of both groups, against the background of a 4-week course of treatment, the acidity of the gastric juice decreased. In particular, in the group of patients with isolated GERD, the pH values increased on average from 1.41 ± 0.17 to 1.62 ± 0.25 and almost approached the parameters of the control group (1.67 ± 0.3) (p < 0.05). In patients with GERD with concomitant diabetes mellitus, there was also a tendency to decrease the acidity of gastric juice in the body and antrum of the stomach.
At the same time, we found that, after a 4-week course of therapy, oxidative stress levels in both patients decreased. In particular, they increased the diameter of the celiac trunk, as well as the speed of blood flow in it. However, in patients of the first group suffering from GERD with combined type 2 diabetes, the diameter of the celiac trunk increased and amounted to 0.91 cm (0.67 cm before treatment), and the blood flow velocity in it increased from 7.27 to 12.19 cm / sec Patients of the third group with isolated GERD also showed a positive dynamics of blood flow in the celiac trunk, and their diameter increased from 0.68 cm to 0.75 cm, and their blood flow velocity increased on average from 9.41 cm / sec to 10 , 83 cm / sec (p> 0.05).
Our data are confirmed by studies [3,4,9,24], however, these authors did not study these indicators for the comorbid course of GERD and type 2 diabetes mellitus. Data on the role of the relationship of ghrelin and oxidative stress was studied [6,7,15,21-23], however, our data allowed us to clarify the relationship of ghrelin with motor-secretory disorders in the presence of a comorbid course of GERD with type 2 diabetes. Data on the role of ghrelin in the mechanisms of the formation of type 2 diabetes mellitus were studied [3,16,18-20] however, our article shows the effect of
ghrelin on the formation of the comorbid course of GERD and type 2 diabetes mellitus.
The works [8,9,10,11,16,17] included data on the severity of the clinical manifestations of isolated GERD, while our work showed a study of the severity of the clinical manifestations of isolated GERD and GERD with concomitant type 2 diabetes mellitus.
Our data indicate that ghrelin plays an important role in the formation of the comorbid course of GERD and type 2 diabetes and changes in its level is one of the factors that significantly complicates the clinical course of GERD and type 2 diabetes.
The data obtained indicate that, along with the normalization of ghrelin level in patients in groups suffering from type 2 diabetes, there was a clear tendency to stabilize the glycemic profile, which indicates a clear connection between this hormone and the clinical course of type 2 diabetes .
Marked positive dynamics of the clinical course of isolated GERD, as well as GERD in combination with type 2 diabetes mellitus against the background of normalization of blood ghrelin indicators. These data suggest that ghrelin plays an important role in the pathogenesis and clinical course of this comorbid pathology.
The data obtained as a result of the study suggest that changes in ghrelin levels and motor-secretory disorders are one of the triggers for the formation of GERD and type 2 diabetes mellitus associated with it, while it contributes to an increase in the clinical picture of each disease.
Conclusions:
1. It was shown that in patients with GERD with concomitant type 2 diabetes there is a marked decrease in ghrelin levels, significantly higher not only with the indices of the control group, but also with patients with isolated GERD.
2. A correlation between the change in ghrelin level, symptoms, pH level and motor-secretory disorders was established.
3. The inclusion of standard therapy in the scheme helps to reduce the onset of clinical remission of not only GERD, but also the normalization of glycemic profile in GERD with comorbid type II diabetes mellitus with the simultaneous normalization of ghrelin indicators.
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IMPROVEMENT OF PHYSICAL FACTORS IN THE LOCAL TREATMENT OF BURN WOUNDS
Osmanov K.
The Federal state budgetary educational institution of higher education St. Petersburg State Pediatric Medical University of the Ministry of Health ofRussia
Bogdanov S.
The state Department of health "Scientific research Institute of regional clinical hospital № 1
named after S. V. Ochapovsky „ Zinoviev E.
The Federal state budgetary educational institution of higher education St. Petersburg State Pediatric Medical University of the Ministry of Health ofRussia
Abstract
The article presents the results of evaluating the effectiveness of the use of low-temperature argon plasma of an arc discharge of atmospheric pressure in the treatment of 2nd and 3rd degree skin burns (ICD-10). Burns had a different etiology (flame, boiling water, contact) and area. The change in the microflora of burn wounds after a single application of the PLAZMORAN installation was determined in three groups of patients, depending on the type of surgical treatment (dermabrasion, early necrectomy with plastic surgery and plastic surgery on granulating wounds). Based on the analysis of bacteriological studies, it was found that the use of low-temperature air plasma of an arc discharge of atmospheric pressure reduces the contamination of wounds by pathogenic microflora.
Keywords: skin burns, low-temperature argon plasma, surgical treatment.
Introduction
Burn injuries in our country range from 3% to 4% of all types of injuries. Every year in Russia, about 400,000 people suffer from burns of various etiologies (thermal, electrical, chemical), of various depths and localizations, 1/3 of which need hospital treatment [2].
The surgeon in his arsenal, in addition to traditional methods of treating burnt skin, has a number of physical factors to influence on burn wounds, which include: ultraviolet radiation, ultrasound, magnetic laser therapy, hydrotherapy, and others [7,8,10]. With the help of them, an antibacterial, proliferative effect, stimulation of capillary circulation, improvement of microcirculation and stimulation of tissue metabolism can be achieved [5].
The use of plasma is one of the promising physical methods of exposure to the wound. It is an ionized gas of high temperature, which consists of charged particles, free electrons, ions, radicals, infrared, ultraviolet radiation [9]. In addition to high temperature and electromagnetic fields, a significant influence factor are plasma components that can damage the cytoplasmic membranes of pathogenic microorganisms and viruses, by affecting their vital systems [4].
In practice, a number of plasma generators of both Russian and foreign production are actively used in the treatment of burn wounds. These include the Plazon (RF), NPC Plasma (RF), The J-Plasma System "USA" and "Neoplas Tools" (Germany).
The above listed medical plasma generators has several disadvantages: the coverage area is from 2 to 10 millimeters, which is limited by the technical characteristics of this equipment; in order to use the equipment, a number of additional components are needed, when the apparatus is in operation it is impossible to provide instant coagulation of microvessels having a diameter of more than 2-3 millimeters.
The use of low-temperature argon plasma of an arc discharge of atmospheric pressure contributes to the improvement of reparative regeneration processes. A complex effect occurs: antimicrobial, hemostatic, proliferative; and the plasma temperature [14] ranges from ± 50 ° C. During the operation of the equipment, argon is used as the working gas during plasma generation. The method is able to ensure the achievement of stable hemostasis, while there is no high-temperature damage to surrounding tissues. Stopping bleeding is achieved by accelerating platelet aggregation and the formation
