Introduction. The spread of gastroesophageal reflux disease (GERD), comorbid with non-alcoholic fatty liver disease, requires modification of methods for non-invasive diagnosis of liver steatosis and fibrosis and concomitant gastrointestinal syndromes.Aim. Substantiation of a modified complex outpatient transabdominal sonographic diagnosis of combined lesions of the liver and intestines in comorbid GERD.Materials and methods. 165 outpatients with GERD (mean age 40.4 ± 2.9 years) underwent clinical and laboratory examinations, ultrasound examination (UE) of the gastrointestinal tract (GIT), liver shear wave elastometry (SWE), esophagogastroduodenoscopy, colonoscopy (CS).Results and discussion. In patients with GERD, a pronounced transsyndromic comorbidity was observed. The degrees of steatosis and fibrosis of the liver according to SWE positively correlated with the biochemical indices APRI and FORNS. ST-index of liver steatosis was statistically significantly associated with the presence of esophagitis, bile sludge, gallbladder polyps and thickening of the colon wall according to ultrasound criteria, sigmoiditis according to CS. Steatosis on ultrasound was associated with male sex, increased waist circumference, lactase deficiency and deficiency of cholecalciferol in the blood, the presence of yeast-like fungi in feces. Liver fibrosis according to the FORNS index directly correlated with the volume of HE-reflux, duodenitis and intestinal damage according to the results of ultrasound, and according to the APRI index, it inversely correlated with the concentration of vitamin D3 in the blood. Fibrosis according to the ESP criteria directly correlated with the presence of hiatal hernia, bile sludge, and the volume of HE-refluxate according to ultrasound criteria; with lactase deficiency, as well as esophagitis and colitis on endoscopic signs.Conclusions. To identify steatosis and liver fibrosis, the SWE methodology can be considered priority, and serum panels of biomarkers – alternative. Ultrasound of the gastrointestinal tract and SWE allow you to identify the degree of steatosis and fibrosis of the liver, the pathology of the esophagus, colon and the biliary system.
Introduction. The growth of gastrointestinal diseases associated with gastroesophageal reflux disease (GERD) dictates the need to develop methodological approaches for early outpatient diagnosis of comorbid gastrointestinal conditions using generally available methods, including transabdominal ultrasound (USR).Aim. To determine significant sonographic parameters of colon lesions in patients with polymorbid GERD, associated with clinical and metabolic concomitant changes, in order to improve transsyndromic diagnosis at an outpatient appointment.Materials and methods. The study included 150 outpatients with GERD (60 men and 90 women) with an average age of 40.2 ± 3.1 years old. All patients underwent clinical and laboratory examination, esophagogastroduodenoscopy, colonoscopy, ultrasound of the gastrointestinal tract with the calculation of the volume of gastroesophageal (GE) refluctate.Results and discussion. In patients with GERD, the criteria reflecting the pathological conditions of the colon according to the data of colonoscopy and ultrasound had a direct correlation. Statistically significant relationships between ultrasound signs of lesions of various segments of the colon with gender, age of patients, body mass index, erosive reflex disease and the volume of GE refluctate, as well as with lactase and vitamin D deficiency, the presence of yeast-like fungi and an increase in the level of fecal calprotectin are shown.Conclusions. The practical significance of the work lies in the possibility of diagnosing morphofunctional disorders of the colon in GERD patients with comorbid gastrointestinal pathology, associated not only with the main, but also with concomitant diseases by the ultrasound technique at the place of medical care. Tuning of gastrointestinal sonography, aimed at the immediate integration of ultrasound images into the patient management plan, involves the expansion of transsyndromic diagnostics and the substantiation of therapeutic tactic at an outpatient appointment.
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