Study goal: Identify clinically significant stigmas of reduced esophageal mucosal resistance.Materials and methods: The study included 181 patients aged 18–70 years with gastroesophageal refl ux disease (GERD).Complaints, age, sex, history of the disease, life history, physical examination data, results of laboratory and instrumental examinations, data on medication intake at the time of enrollment of the patient for the main disease and concomitant pathology were noted in the individual registration card (IRC).Results: The study demonstrated the presence of features suggesting with a higher degree of probability a reduced esophageal mucosal resistance in a certain group of patients with GERD. Individuals with early- onset GERD, males, young adults, smokers, and individuals with a high body mass index (BMI) have a higher risk of esophageal mucosal erosions. The presence of esophageal hernia of the diaphragm (EVD), intake of acetylsalicylic acid (ASA), calcium channel blockers (CCBs), or nonsteroidal anti-inflammatory drugs (NSAIDs) are factors that reduce esophageal mucosal resistance. The formation of erosive esophagitis is not associated with the subjective perception of GERD symptoms and does not affect the patient’s complaints.Conclusion: Clinical manifestations of GERD are not associated with the degree of esophageal mucosal damage and cannot be a phenotypic sign of erosive esophagitis requiring mandatory prescription of an esophagoprotector. Clinically significant stigmas of decreased esophageal mucosal resistance were revealed. The need in research of expediency and efficacy of prescription of esophagoprotector in patients with GERD, having GVHD or regularly taking BCA, ASA and other NSAIDs, including obligatory estimation of therapy effi cacy taking into account patient gender and age, has been established.
Gastroesophageal reflux disease (GERD) is the most common of all acid-related diseases, it is recognized as the leading cause of esophageal adenocarcinoma. The natural factor of protection against aggressive refluxate components is the integrity of the esophageal mucosa, which performs a barrier function with the participation of a number of mechanical, chemical and immunological mechanisms. Their damage under the regular influence of acidic or mixed reflux causes the development of the pathological process. The review was prepared to systematize knowledge of the main components of mucosal barrier of the esophagus providing resistance of mucosa under conditions of GERD. The literature was searched in Embase, PubMed, and Google Scholar using the keywords: gastroesophageal reflux disease, mucosal protection, esophageal mucosa epithelium, dense contact proteins, epithelial protection, esophagoprotection. The main structural and functional components of esophageal mucosal protection were emphasized
Aim: to evaluate the efficacy and safety of combined therapy with a proton pump inhibitor (PPI) and an esophagoprotector to relieve the symptoms of reflux esophagitis, improve the life quality of patients and achieve faster and complete disease remission. Patients and Methods: a randomized study included 60 patients, including 33 men (mean age 40.96±13.44 years) and 27 women (mean age 48.29±12.69 years) with a duration of gastroesophageal reflux disease (GERD) of 21.85±15.48 months and C/D stage of reflux esophagitis. Depending on the prescribed treatment, the patients were divided into 2 groups of 30 subjects. Patients of the main group received complex therapy: PPI pantoprazole 40 mg once per day and esophagoprotector based on hyaluronic acid, chondroitin sulfate and poloxamer 407. In the comparison group, only pantoprazole was prescribed at the same dosage. The duration of the treatment course in both groups was 4 weeks. Before and after treatment, the presence and severity of complaints were assessed on the Likert scale, life quality according to the SF-36 questionnaire and endoscopic examination data. Results: after the end of the therapy course, a statistically significant decrease in the severity of epigastric burning, regurgitation, substernal pain, gaseous eructation, odynophagia and dysphagia was found both in the main group (in all cases p<0.05, Wilcoxon Matched Pairs Test) and the comparison group (in all cases p<0,05, Wilcoxon Matched Pairs Test). The use of combination therapy made it possible to achieve a more significant improvement in the life quality of patients in all indicators versus PPI monotherapy. In addition, 3 (10%) patients of the main group achieved endoscopic remission, while there were no such patients in the comparison group. The use of esophagoprotector in addition to PPI made it possible to reach the primary and secondary endpoints significantly more commonly versus during monotherapy. Conclusion: the obtained data indicate the high efficiency and safety of PPI therapy in combination with esophagoprotector for relieving the disease symptoms and improving the life quality of patients, faster and complete remission of reflux esophagitis by additional restoration of the esophageal mucosa resistance. Esophagoprotector as a component of complex therapy together with PPI allows achieving clinical and endoscopic disease remission in patients with erosive esophagitis in shorter terms. KEYWORDS: gastroesophageal reflux disease, esophageal mucosa resistance, esophagoprotection, proton pump inhibitor, quality of life. FOR CITATION: Matoshina I.V., Livzan M.A., Fedorin M.M., Lapteva I.V. Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):366–372 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-366-372.
Цель исследования: комплексная оценка эффективности достижения клинической, эндоскопической и гистологической ремиссии при применении комбинированной терапии ингибитором протонной помпы (ИПП) и эзофагопротектором. В проспективное рандомизированное исследование включены 60 пациентов (средний возраст 43,23±13,06 года) со стадией рефлюкс-эзофагита С/D, из них 33 мужчины и 27 женщин. Длительность гастроэзофагеальной рефлюксной болезни (ГЭРБ) составила 21,85±15,48 месяца. Пациенты основной группы (30 человек) получали комплексную терапию: ИПП пантопразол 40 мг 1 раз в день и эзофагопротектор. Пациенты в группе сравнения (30 человек) получали только пантопразол в той же дозировке. Продолжительность курса лечения составила 4 недели. До лечения и через 4 недели от начала терапии оценивали наличие и выраженность жалоб по шкале Лайкерта, результаты эндоскопического и морфологического исследования. Через 4 недели от начала терапии в обеих группах установлено статистически значимое снижение выраженности характерных симптомов ГЭРБ. У 3 (10%) пациентов основной группы была достигнута эндоскопическая ремиссия. Комбинированная терапия позволила добиться более выраженной редукции гистологических изменений, существенного повышения экспрессии белков плотных контактов (клаудина-1, и клаудина-4) и снижения экспрессии маркера клеточной пролиферации Ki-67. Наиболее существенные различия в скорости восстановления имелись в области эрозивных участков. Применение эзофагопротектора в дополнение к ИПП позволило достигать поставленной первичной и вторичных конечных точек существенно чаще. Полученные данные демонстрируют высокую эффективность комбинированной терапии ИПП с эзофагопротектором для купирования симптомов заболевания, более быстрой и полной ремиссии рефлюкс-эзофагита. Комплексная терапия эзофагопротектором совместно с ИПП позволяет достичь клинической, эндоскопической и гистологической ремиссии эрозивного рефлюкс-эзофагита в более сжатые сроки. Ключевые слова: гастроэзофагеальная рефлюксная болезнь, слизистая оболочка эпителия пищевода, эпителиальная защита, эзофагопротекция.
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