Background. The indicators of heart rate variability reflect the vital processes of managing the physiological functions of the body — autonomic balance and functional reserves of its management mechanisms, the adaptive capacity of the body, and stress resistance. At the expressed disturbances of autonomic nervous system homeostasis, the risk of emergence and progression of diseases increases. This is especially true for the elderly, who are characterized by comorbidity. The purpose of the study was to assess the state of adaptive capacity and autonomic regulation of the body in patients with precancerous conditions of the stomach with the thyroid gland pathology. Materials and methods. Seventy-two patients with chronic atrophic gastritis were divided into groups: group I consisted of 34 patients with nodules in the thyroid gland; group II included 23 patients with pathological changes of the thyroid gland and 15 patients of group III had a normal thyroid gland. The heart rate variability was assessed based on the results of PRECISE-diagnostics. To diagnose the functional state of the small intestinal microbiota, a hydrogen breath test was performed. Results. In 81.9 % of patients with chronic atrophic gastritis and thyroid pathology, an imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system with a prevalence of vagotonia including the patients with thyroid nodules (64.7 %) and pathological changes in the thyroid gland (56.5 %) (р < 0.05). A significant violation of the body’s adaptive capacity was found in 63.2 % of patients with chronic atrophic gastritis. The frequency of reduced adaptive capacity of the organism was twice higher in patients with comorbid pathology (p < 0.05). 56.1 % of patients with chronic atrophic gastritis associated with thyroid pathology experienced a decrease in functional reserves of the body. In the spectrum of detected disorders, 68.8 % of patients presented with depletion of functional reserves of the body with increased central control and 31.2 % of patients — hormonal imbalance with a predominance of the humoral link with the inclusion of autonomous control (p < 0.05). The analysis of the stress index showed in half of the examined patients insufficient stress resistance with a probable increase in mean figures to (136.8 ± 7.4) m/s (p < 0.05). Correlations were found between the frequency of detection of excessive bacterial growth syndrome and maladaptation (r = 0.64; p < 0.05), imbalance of the sympathetic and parasympathetic parts of the autonomic nervous system (r = 0.59; p < 0.05). Conclusions. The course of chronic atrophic gastritis associated with thyroid pathology is associated with an imbalance of sympathetic and parasympathetic parts of the autonomic nervous system, depletion of adaptive mechanisms, reduced functional reserves of the body, and stress resistance. At the same time, disorders of the body’s adaptive potential and changes in autonomic balance are associated with the disorders of the small intestinal microbiota, which requires a multidisciplinary approach to the management of patients with comorbid pathology of the stomach and thyroid gland.

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Introduction. There are some data that suggest that emotional stress and depression may affect the development of functional organic disorders of the gastrointestinal tract. However, the relationship between them is not fully understood. It is not unknown the relationship between stress / depression and chronic gastritis. Aim: to analyze the published articles and online sources on depressive disorders with an emphasis on the impact of the COVID-19 pandemic, and investigate the depression level in patients with chronic atrophic gastritis with intestinal metaplasia, with or without gastric dysplasia. Materials and methods. Literature data were studied for 2004-2021 using Internet resources in English, Ukrainian, and Russian language. Using the HADS scale («The hospital Anxiety and Depression Scale»), the level of depression was studied in 76 patients with chronic atrophic gastritis (with intestinal metaplasia, with or without gastric dysplasia). Statistical data analysis was performed with SPSS Version 13.0. Results. Having used Internet resources and scientific publications, depressive manifestations, according to the International Classification of Diseases (ICD-10), diagnostic methods, the prevalence of depressive disorders before and during the pandemic COVID-19, as well as the impact of COVID-19 on the severity of depressive manifestations were studied. Additionally, it was found in this study that 23.7 % of patients with chronic atrophic gastritis had depressive changes. 13.2 % of these changes were subclinically expressed, and 10.5 % of ones were clinically expressed and required psychocorrective therapy. Conclusions. The COVID-19 pandemic is a trigger in society that may exacerbate depression in patients with other comorbid diseases and in the general population. Depressive changes requiring psychocorrective therapy were revealed in 23.7 % of patients with chronic atrophic gastritis with intestinal metaplasia. Keywords: Depression, general population, COVID-19, chronic atrophic gastritis, intestine metaplasia, dysplasia.

Background. Due to the need to assess the impact of comorbid pathology (GERD and Oddi sphincter dysfunction), it is not possible to use such well-known specific questionnaires as the GERD Health-Related Quality of Life Questionnaire, the Quality of Life in Reflux and Dyspepsia and others. The purpose: to study Health-Related Quality of Life (HRQoL) before and after treatment in patients with GERD, combined with dysfunction of the sphincter of Oddi, using Short Form Health Status Survey (SF-36) and the self-developed specific questionnaire. Materials and me­thods. 30 patients with comorbid diseases GERD and Oddi’s sphincter dysfunction were studied. SF-36 and the self-developed specific questionnaire were used. Results. The specific questionnaire for patients with gastoesophageal reflux disease combined with Sphincter of Oddi dysfunction was worked out. The evaluation of the questionnaire (patients comprehensiveness of questions, timesuming etc.) was explored. Using SF-36, it was significant improvement of HRQoL for all scales after treatment compared with initial data: physical functioning (PF, (77,1 ± 2,0) versus (71,4 ± 2,2)), role-physical functioning (RP, (52,1 ± 5,0) versus (30,6 ± 2,4)), bodily pain (BP, (65,8 ± 1,2) versus (48,7 ± 2,1)), social functioning (SF, (69,5 ± 2,0) versus (50,8 ± 2,1)), mental health (MH, (68,5 ± 2,1) versus (49,8 ± 1,8)), role emotional (RE, (65,2 ± 4,7) versus (35,8 ± 3,7)), vitality (VT, (63,3 ± 2,1) versus (43,2 ± 2,2)), general health (GH, (58,1 ± 2,4) versus (46,1 ± 1,7) points). All patients had decreased HRQoL due to comorbid GERD and sphincter dysfunction Oddi. Moderate or significant disorders of activity and rhythm of life due to these diseases was revealed, but after treatment there was an improvement in significant HRQoL in all patients, in addition to psycho-emotional perception of their diseases became more positive. Conclusions. All patients had decreased HRQoL due to comorbid GERD and sphincter dysfunction Oddi, and it improved after treatment in most of patients.

Background. Indicators of heart rate variability are reliable and objective indicators of the tone of the autonomic nervous system (ANS), which reflects changes in the psycho-emotional state of man against the background of stress. Stress management programs include a variety of relaxation techniques and cognitive behavioral therapy. Therefore, the purpose of the study was to optimize the treatment of patients with chronic atrophic gastritis with autonomic disorders using software and hardware for parasympathetic activation of the ANS. Materials and methods. Indicators of heart rate variability were studied in 80 patients with chronic atrophic gastritis based on the results of PRECISE diagnostics, which allowed to identify patients with hypersympathicotonia and treat them with 10 sessions on Pure Purr software and hardware complex to assess the dynamics of heart rate variability. Results. 72.7 % of patients with chronic atrophic gastritis, who showed a decrease in heart rate variability due to activation of the sympathetic tonic ANS and insufficient activity of its parasympathetic tonic, breakdown of adaptation, lack of stress and functional reserves of the body were treated with neurostimulation. After treatment, positive dynamics was determined in the form of a significant increase in heart rate variability by increasing its components due to the parasympathetic nervous system, which prevents increased sympathetic influences and improves disease and prognosis by normalizing adaptation, functional reserves and stress resistance. Conclusions. Treatment of patients with chronic atrophic gastritis with autonomic disorders should be comprehensive with the inclusion of hardware with neurostimulation software aimed at reducing hypersympathicotonia with increasing adaptive capacity of the body.