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MEDICAL SCIENCES / «<g®[L[L®@U[]UM~J0U®MaL» ®4W7)), 2024
УДК 616.329-002-02:616.33-008.17] -036.1-072.1-073
Honcharuk L.M.,
PhD in Medical Sciences, Associate Professor Department of Internal Medicine;
Andrushchak M.O., PhD in Medical Sciences, Associate Professor of Department of Infectious Diseases and Epidemiology Buk ovinian State Medical University Katrich M. V., 6th year student Bukovyna State Medical University, Chernivtsi, Ukraine Maidanyk K. Y., 6th year student Bukovyna State Medical University, Chernivtsi, Ukraine
Makhno M. V. 6th year student Bukovyna State Medical University, Chernivtsi, Ukraine DOI: 10.24412/2520-6990-2024-4197-20-21 MODERN DIAGNOSIS OF GASTROESOPHAGEAL REFLUX DISEASE
Abstract.
The current aspects of diagnosis of gastroesophageal reflux disease (GERD) are considered in the work. Keywords: gastroesophageal reflux disease, esophageal-rNmonitoring, esophagogastroduodenoscopy.
Introduction. Gastroesophageal reflux disease (GERD) received official recognition at the international congress of gastroenterologists in 1997 in Belgium [3].
It was found that this pathology has started to spread quite quickly in recent years, according to statistics, it is 20-40% [1, 2]. This disease is also common in Ukraine. It affects 25.1% of men and 39.1% of women [3]. The actuality of GERD is accompanied by typical and atypical clinical manifestations, one of these clinical manifestations is heartburn. According to a systematic review of 10 studies, the prevalence of nocturnal heartburn and/or regurgitation ranges from 21 to 59% [4,5].
In most patients, the symptoms of GERD are mild and sporadic, for which they do not consult a doctor, or they take medication on their own and use the advice of friends. These patients account for 70-80% of all cases of the disease. The average part of patients are patients with reflux esophagitis (20 - 25%), who have pronounced permanent symptoms, which require regular outpatient observation and treatment. And a small group of patients (2 - 5%) who developed complications : bleeding, strictures of the esophagus, and who require inpatient treatment [6, 7].
The aim of the study. Study of etiopathogenesis, with the aim of better diagnosis of GERD.
Materials and methods. Theoretical analysis and generalization of literary and Internet sources.
Discussion of research results.
The diagnosis of GERD is based on clinical manifestations, physical examination, and performed endoscopy with biopsy of the gastric mucosa, gastroduo-denoscopy, X-ray, computer and magnetic resonance imaging [8].
Esophagogastroduodenoscopy (EGDS) is performed to identify or exclude significant damage in individual cases. With typical symptoms of GERD, it is not necessary to conduct an EGD. In case of complications of GERD, during EGDS, a biopsy of the esophagus is taken for the study of neoplasms, for the diagnosis of eosinophilic esophagitis [15,16,17].
During the research, attention was drawn to the fact that such endoscopic signs as erythema, swelling, and tenderness, according to the Genval consensus (1999), are not evidence of the existence of GERD due to the subjectivity of their assessment. In such cases, endoscopists confirm endoscopically negative reflux disease. It should also be noted that GERD sometimes has an asymptomatic course, which in turn is accompanied by endoscopic signs of reflux esophagus [9].
During the second plenary session on the topic: " GERD and functional disorders of the esophagus: differential diagnosis and differential treatment (presentation of diagnostic possibilities of esophageal-imped-ance-pH-monitoring)", during which the report of Assoc. S.G. Melashchenko (moderator: Prof. V. M. Chernobrovii), which discussed a new method of diagnosing GERD, namely esophageal impedance measurement. This method of registering liquid and gas refluxes, which is based on measuring the resistance (impedance) to the alternating electric current of the contents entering the esophageal cavity [10]. Thanks to this method, it is possible to determine the episodic nature of reflux into the esophagus, taking into account the pH and other physical characteristics of the reflux-ate (gas, liquid). The principle of operation of the device is to register changes in impedance in several measured segments, which are located on a microcath-eter in the esophageal cavity. The idea of creating this technique belongs to German engineer Jiri Silny and
«шиитеимм-лэишаи» 2024 / MEDICAL SCIENCES
Belgian gastroenterologist Daniel Sfrim, who developed a prototype in the early 90s of the last century. The method has proven its effectiveness and has become one of the most informative tools for registering pathological gastroesophageal reflux over the past 20 years of experimental and clinical use of multichannel intraluminal impedance-pH-metry (MII-pH-M) [11, 12, 13].
As is known, the key link in the pathogenesis of GERD is a violation of the constrictive function of the lower esophageal sphincter and the thoracic part of the esophagus, which leads to excessive exposure of aggressive substances that enter the esophagus from the stomach and duodenum In traditional esophageal pH monitoring, the threshold pH < 4, when pepsinogen activation occurs, is considered critical. However, some isoforms of this enzyme show activity even at higher values. There is probably also a damaging effect of bile acids in duodenogastroesophageal reflux This explains the relevance of registering not only acid reflux, but also slightly acidic (4 < pH < 7) and slightly alkaline (pH > 7). MlI-рН-М has unconditional advantages in the assessment of alkaline refluxes. In most cases, calcification of the esophagus occurs due to mouthfuls of saliva, and this is clearly diagnosed with simultaneous impedance monitoring [14].
The diagnosis of acid reflux is also becoming more accurate — rereflux is detected, when several boluses of stomach contents enter the esophagus in one pH wave. The illusion of reflux on the pH-gram is sometimes created by a sharp change in acidity due to the anterograde arrival with saliva of portions of acid that entered the pharynx earlier. With the help of this study, the quality of the diagnosis of acid reflux increases, which in a specific clinical situation can be of decisive importance [13].
Also, with the help of esophageal-impedance-pH monitoring, it is possible to effectively diagnose aero-phagia caused by gas reflux, examine patients after gastric surgery and patients with atrophic gastritis, in which in most cases the esophageal refuxate has pH>7, which is mainly caused by bile reflux [14].
Conclusion. This article provides a diagnosis of GERD. The expediency of using esophageal imped-ance-monitoring-pH-monitoring, daily esophageal-pH-monitoring in diagnostics, which make it possible to better diagnose not only acid, weakly acid, but also weakly alkaline refluxes.
Список л^ератури:
1. Delshad S. D., Almario C. V., Chey W. D., Spiegel B. M. R. Prevalence of gastroesophageal reflux disease and proton pump inhibitor-refractory symptoms // Gastroenterology. — 2020. — Vol. 158 (5). — P. 1250 — 1261.e2. doi: 10.1053/j.gastro.2019.12.014.
2. Nirwan J. S., Hasan S. S., Babar Z. U., Conway B. R., Ghori M. U. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis // Sci. Rep. — 2020. — Vol. 10 (1). — 5814. doi: 10.1038/ s41598-020-62795-1.
3. Харченко, Н.В., Бабак, О.Я., Фомш, П.Д, Матюха, Л.Ф., Ткач, С.М., Захараш, М.П. (2013) Гастроезофагеальна рефлюксна хвороба. Адаптована клшчна настанова, заснована на доказах 31 с.
4. Мшстерство охорони здоров'я украгни харювський нацюнальний медичний унiверситет.
21
«Основи дагностики, лкування та профшакшки основних хвороб opraHÍB травлення» (2012).
5. Heading R. C. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review // Scand. J. Gastroenterol. Suppl. — 1999.
— Vol. 231. — P. 3 — 8.
6. Garrett, D. M., & Hachem, C. (2018). Gas-troesophageal reflux disease (GERD). Missouri medicine, 115(3), 214.
7. Yadlapati, R., Gyawali, C. P., Pandolfino, J. E., Chang, K., Kahrilas, P. J., Katz, P. O., ... & Wani, S. (2022). AGA clinical practice update on the personalized approach to the evaluation and management of GERD: expert review. Clinical Gastroenterology and Hepatology, 20(5), 984-994.
8. Фартушняк, Л.В., Новицька, 1.О., Довганюк, Н.1., Воевщка, О.С., Гайдичук, В.С. (2004) Сучасш аспекги дагностики га лжування гастроезофагальног рефлюксог хвороби. Буковин-ський медичний вюник. Т.8, №3. С.209-213. URI: http://dspace.bsmu.edu.ua:8080/xmlui/h an-dle/123456789/7289
9. Адаптована клшчна настанова, заснована на доказах, «Гастроезофагеальна рефлюксна хвороба» (наказ МОЗ Украгни № 943 вщ 31 жовтня 2013 р. «Про затвердження та впровадження ме-дико-технолопчних документв по стандартизацп медичног допомоги при гасгроезофагеальнiй ре-флюкснiй хворобi»).
10. Трухманов А.С., Кайбышева В.О. рНимпе-дансометрия пищевода. Пособие для врачей / Под ред. В.Т. Ивашкина.— М.: ИД «МедпрактикаМ», 2013.— 18 с.
11. Sifrim D., Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors // Gut.— 2012.— Vol. 61 (9).— P. 1340—1354.
12. Sifrim D., Silny J., Holloway R., Janssens J. Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance // Gut.— 1999.— Vol. 44.— P. 47—54.
13. Чернобровий В.М., Мелащенко С.Г. Сучасш аспекти дагностики i фармакотерапи гастроезофагеальног рефлюксног хвороби // СУЧАСНА ГАСТРОЕНТЕРОЛОПЯ. - 2013 -№3- С. 92-99.
14. Чернобровий В.М., Мелащенко С.Г., Ксенчин О.О., Гастроезофагеальна рефлюксна хвороба: функциональна дiагностика, вибiр iнгiбiторiв протонног помпи та ощнка ефекгивностi гх кислотосупресивног ди // СУЧАСНА ГАСТРОЕНТЕРОЛОПЯ.- 2015 -№3- С. 50-58.
15. Hunt R. Global perspective on gastroesophageal reflux disease [Electronic resource] / R. Hunt, D. Armstrong, P. Katelaris // Global World Gastroentero-jogy Organisation Global Guidelines, 2015. - URL: http //www Guidelines Global Guidelines: GERD: Englich.
16. De Bortoli N. Esophageal testing; What we have so far / N. De Bortoli, I. Martinucci, I. Bertani // World J. Gastrointest. Pathophysiol. - 2016. - № 7 (1).
- P. 72-85.
17. Бойко Т. В. Сучасш аспекти дагностики гастроезофагельног рефлюксног хвороби //Здо-бутки клшчног i експериментальног медицини. 2017.-№ 2 -С. 8-12.
