From year to year, wide spread of gastroesophageal reflux disease (GERD) is attracting greater attention of specialists in the field of this pathology diagnosis and treatment. In-depth studies on etiological and pathogenetic factors in the GERD development are being conducted. Of particular interest is the role of humoral factors, one of which is vasoactive intestinal peptide (VIP). There are currently no data on the dynamics of this hormone during surgical treatment of GERD. The aim of the study was to examine the dynamics of plasma VIP during surgical treatment of GERD and its influence on the lower esophageal sphincter (LES) function. Materials and methods. Surgical treatment in the Nissen modification was performed for 35 patients with GERD. There were 26 women (74.3 %), men – 9 (25.7 %). mean age – 55.3 ± 11.3 years. Comparison group – 20 apparently healthy individuals: women – 14 (70.0 %); men – 6 (30.0 %), mean age – 56.7 ± 10.6 years. VIP was measured in venous blood plasma by an enzyme immunoassay (Vasoactive intestinal peptide ELISA, S-1201, BCM Diagnostics) using an immunoenzyme complex ImmunoChem-2100 (USA). The sampling of the studied samples in the main group was carried out before the operation and 2–3 months post-surgery. Results. In the main group before the surgery, the level of VIP was 3.1 ± 1.1 ng/ml, after the surgery – 2.2 ± 1.0 ng/ml. In the comparison group, VIP was determined at the level of 2.1 ± 1.1 ng/ml. In GERD before the surgery, the VIP level was statistically different from the indicators in the comparison group and from postoperative values. After surgical treatment, VIP values were decreased to the level of apparently healthy individuals. There was a positive correlation between the VIP level and acid exposure time (AET), the total number of refluxes, the number of reflux events longer than 5 minutes, the maximum duration of refluxes and the degree of esophageal inflammation. Conclusions. In the surgical treatment of GERD, the statistically significant decrease in the VIP level to that of apparently healthy individuals is determined. The moderate positive correlation between the levels of VIP, AET, the average number of refluxes, the number of reflux events longer than 5 minutes, and the maximum duration of refluxes confirms the inhibitory effect of VIP on LES tone. The relationship between the degree of esophageal inflammation and the VIP level confirms the indirect, through the action of VIP, inhibitory effect of the esophagitis severity on the LES tone.
Gastroesophageal reflux disease (GERD) is one of the most common gastroenterological diseases. Therefore, the issues of diagnosis and the most effective treatment of GERD are extremely relevant. Achieving a stable positive result of treatment is impossible without taking into account the pathogenetic mechanisms of the development of GERD. Particularly relevant are the little-studied issues of the influence of humoral factors on the development of GERD in the course of treatment. One of the interesting biologically active substances is prostaglandin E2, the possible involvement of which in the mechanisms of the development of GERD is insufficiently reported. The aim of the study is to evaluate the effect of antireflux surgery on the level of prostaglandin E2 in blood serum and to verify that its changes after surgical treatment are associated with the decrease of gastroesophageal reflux and esophageal inflammation. Materials and methods. 35 patients were examined with GERD who underwent laparoscopic total antireflux fundoplication. There were 26 women (74.3 %) and 9 men (25.7 %). Their age is 55.3 ± 11.3. The control group consisted of 20 practically healthy people (women – 14 (70.0 %), men – 6 (30.0 %), average age – 56.7 ± 10.6). Immunoenzymatic analysis of prostaglandin E2 was performed in blood plasma, which was obtained according to a standard method. Determination of prostaglandin E2 (Prostaglandin E2 ELISA, KGE004B, RnD Systems) was carried out by the immunoenzymatic method based on the use of the “sandwich“ variant of the solid-phase immunoenzymatic analysis. The procedure was carried out on the immunoenzyme complex ImmunoChem-2100 (USA) at the Department of Clinical Laboratory Diagnostics in Zaporizhzhia State Medical University. Research on the level of prostaglandin E2 in the main group was carried out before surgical treatment and 2–3 months after surgery by taking venous blood and using the above test systems. Statistical evaluation of the research results was performed using the Statistica for Windows 13 software package (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. The level of prostaglandin E2 in the blood of practically healthy people was 16.7 ± 6.1 pg/ml. In the main group, the values of prostaglandin E2 before surgical treatment were 25.8 ± 5.7 pg/ml, after surgical treatment, they decreased to 13.5 ± 5.3 pg/ml. The detailed analysis of patients in the main group showed that the level of prostaglandin E2 did not differ statistically in different erosive forms of esophagitis, or CLE and NERD. But it is statistically different from the level of prostaglandin E2 in practically healthy individuals of the control group. The conducted correlation analysis indicated that the level of prostaglandin E2 did not depend on the duration of acid exposure in the esophagus, as well as on the severity of esophagitis or the presence of CLE. Conclusions. With effective surgical treatment of gastroesophageal reflux disease, a decrease in the level of prostaglandin E2 after surgery is determined compared to preoperative data to the level obtained in a group of practically healthy patients. The obtained dynamics of the level of prostaglandin E2 indicates the possibility of this hormone influencing the tone of the lower esophageal sphincter and active participation in the pathogenesis of GERD, which confirms the possibility of its use as an additional diagnostic marker of inflammation in the esophagus and a marker of the effectiveness of surgical treatment.
Objective. To study the immediate and late follow-up results of treatment in patients, suffering hemorrhoids, to whom transanal hemorrhoidal desarterization under ultrasound rectodopplerometry control was done, and to compare them with results of treatment in patients, operated in accordance to procedure of standard hemorrhoidectomy. Materials and methods. There were analyzed the results of treatment of 111 patients, suffering hemorrhoids. The main group have consisted of 50 patients, to whom transanal hemorrhoidal desarterization under ultrasound rectodopplerometry control was performed. Into control group 61 patients were included, who were operated in accordance to Parks procedure. Results. In the main group the average time of the operation have constituted (50.1 ± 1.4) min, the patient stationary stay - (9.9 ± 0.7) days, the pain syndrome intensity in postoperative period was estimated as 2 - 3 points, what have appeared significantly lesser, than in the control group of the patients (p < 0.01). Good late follow-up results were achieved in 100% patients of the main group and in 88% of the control group. Conclusion. There was established, that transanal hemorrhoidal desarterization under ultrasound rectodopplerometry control permits to reduce essentially the average time of the operation, the patients’ stationary stay, to lower the pain syndrome intensity, and to improve late follow-up results of the hemorrhoids treatment.
A hiatal hernia occurs in 83–94 % of patients with gastroesophageal reflux disease (GERD). Difficulties in diagnosing endoscopic signs of gastroesophageal reflux with combination of the most common hiatal hernia types remain relevant. Untimely and inaccurate endoscopic interpretation of these pathological changes significantly reduces the effectiveness of treatment. The aim of the research was to study the endoscopic signs of gastroesophageal reflux disease with the most common hiatal hernia type I and type III. Materials and methods. The examination results of 153 patients with GERD and the most common hiatal hernia type I and type III at the stage of preparation for antireflux surgical treatment were analyzed. The age was 54.5 ± 11.3, there were 48 (31.4 %) men, 105 (68.6 %) women. In Group I – 85 patients with GERD and type I hiatal hernia, in Group II – 68 patients with GERD and type III hiatal hernia. A complete preoperative examination necessarily included endoscopy with chromoendoscopy (mainly NBI or FICE), biopsy from suspicious foci of the gastric mucosa and the lower third of the esophagus followed by histological analysis. Statistical processing and mathematical analysis of the obtained results were performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). For comparative analysis the arithmetic mean and standard deviation were calculated and presented as M ± s. Differences between groups were assessed using the sub-module “Difference tests” in the module “Basic statistics and tables”. Differences at P < 0.05 were considered statistically significant. Results. In both groups, non-erosive forms of gastroesophageal reflux disease prevailed: 57 (67.1 %) and 39 (57.4 %) patients respectively. Both in Groups I and II, among the erosive forms there were mainly LA A stages of esophagitis – 20 (23.5 %) and 17 (25.0 %). СLE signs of the esophageal mucosa prevailed in Group I – 16 (18.8 %) patients, in Group II – 5 (7.4 %) patients. The proximal edges of the gastric folds, which are visualized in all patients, were considered the reference point for the true esophageal-gastric junction. Complicated course of GERD was noted in both groups of patients. Conclusions. Endoscopic signs of GERD with hiatal hernia type I or type III have characteristic features, the severity of which manifestation does not depend on the type. A reliable indicator of the true esophageal-gastric junction location is the proximal edge of the gastric folds. Complicated course of GERD occurs in both groups: Barrett’s esophagus and Schatzki’s ring predominate in the Group I, strictures and ulcers of the esophagus – in the Group II.
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology. In more than 80–90 % of patients, GERD is caused by the presence of hiatal hernia, leading to the failure of the lower esophageal sphincter. Therefore, experts increasingly agree that GERD can be effectively treated surgically in this case with a detailed diagnosis and assessment of hiatal hernia types. One of the most common methods for diagnosing hiatal hernia is radiological. But the results of the data interpretation obtained during preparation for surgical treatment are contradictory. This situation requires work continuation in this direction. The aim of the study was to improve radiological diagnosis and conduct a detailed analysis of the hiatal hernia types in GERD patients. Materials and methods. The examination results of 120 patients with GERD were analyzed. The mean age was 55.1 ± 10.7, there were 34 (28.3 %) men, 73 (71.7 %) women. In all patients, polypositional radiological examination (“Opera T 90cex”, “General Medical Merate S.p.A.”, Italy) of the esophagus, stomach with a water-soluble contrast agent (barium), photographic fixation, video recording and video analysis was performed. An internationally accepted classification was used to assess the hiatal hernia types. All patients were candidates for surgical treatment by laparoscopic cruroraphy and Nissen or Toupet fundoplication. The results of the preoperative examination were specified intraoperatively. Statistical processing of the obtained results was performed using the Statistica for Windows 13.0 software package (StatSoft Inc., USA). Results. In all patients, hiatal hernias were diagnosed. Type I hernias – in 94 (78.3 %) patients, type II hernias – in 3 (2.5 %), type III hernias – in 15 (12.5 %), type IV was detected in 8 (6.7 %) patients. The features of radiological diagnostic of hiatal hernia types were analyzed in detail, and steps to improve it were proposed. The issues of large and giant hernias diagnosis and definition were addressed. All results were illustrated with our own photographic material. A quantitative and qualitative assessment of the obtained results was carried out. Conclusions. The leading role of various hiatal hernia types in the development of GERD has been suggested. Type I hiatal hernia has been presented as the most common among such patients. Detailed X-ray diagnostics with the use of photographic fixation, video recording and video analysis has been shown to be the important and effective method for determining the anatomical features of hiatal hernia types as the main factors of the esophagogastric junction disruption and, consequently, the development of GERD.
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