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The purpose of this study was to assess clinical manifestations and to classify of hospital-based gastroesophageal reflux disease (GERD) and to compare of various schemes of antireflux therapy among adults in Mongolia.
The criteria of selection patients to this study was pH -positive GERD. In our study 172 patients with GERD (female 79, male 93, mean age 34.8) and 126 healthy persons (female 67, male 59, mean age 33.5) were inrolled. Diagnosis was confirmed by combination of clinical, pH-metric, endoscopic and histological examinations. Helicobacter pylori (H.pylori) was determined histologically and by urease test. Reflux esophagitis (RE) was graded according to Los Angeles classification. According to our study, symptomatic GERD occurs in 23.8% (41pts) of patients, while RE presents in 76.1% (131 pts). The data shows that among hospital-based GERD patients were predominated endoscopic positive reflux, on the other hand symptomatic GERD patients visit to hospital rarely. Among endoscopic positive reflux patients we had detected only 37 (or 28.2% of total patients) patients had independent RE, but 63 (48.0%) patients had chronic gastritis, and 31 (23.6%) patients had combined gastroduodenal peptic ulcer. We recorded that peculiarity of hospital based GERD in Mongolia is the association of gastroduodeanal pathology. GERD patients depending on following endoscopic appearances were divided into four groups: group 1 - 41 patients with symptomatic reflux, group 2-37 patients with only RE, group 3-63 patients of RE combined with chronic gastritis, and group 4-32 patients with RE and peptic ulcer disease. The morphological and physiological findings among four groups are presenting various clinical forms of GERD, which differentiated by the activity of RE, the occurrence of Barrett's esophagus, the presence of H.pylori infection, and the circadian rhythm of intraesophageal and intragastric acidity, including acid reflux episodes, basal or maximal acid output of stomach.
Clinical manifestation of group 1: Those patients from our study demonstrate lack of any esophageal and gastric mucosal injury, consequently found lower prevalence of H.pylori infection. We suggested that 24.3% of occurrence of H.pylori infection in group 1 compare with the frequency of H.pylori infection in Mongolian populations have no clinical important. But our results of 24-h pH metry showed that all of DeMeester and Johnson's criteria of gastroesophageal acid reflux was higher among group 1 than criteria of healthy control. This argument is supporting that the direct diagnosis of ambulatory 24-h esophageal pH monitoring varies according to the different GERD groups. In our study defined 7.3% case of BE without dysplasia in group 1, that serves of long lasting influences of acid reflux into esophageal mucosa. Clinical manifestation of group 2: Findings from our study demonstrate that RE patients have a significantly greater esophageal exposure to acid than do patients of group 1. Consequently, the frequency of BE and dysplasia were presented more often among RE patients (x2=48.16, df 13, p<0.001). So group 2 presented 21.6% of BE, and 2 cases of dysplasia than differs from symptomatic reflux group (p<0.01). Our research illustrates that H.pylori infection in patients with independent RE occurs in 36%, that no significant from prevalence of H.pylori infection among patients group 1 (p>0.01). Clinical manifestation of group 3: Most patients of this group exhibit a higher rate of reflux episodes than do NERD (p<0.01) and do independent RE patients (p<0.01). Our recent study was shown that the important for clinical features of RE patients with accompanied gastroduodenal pathology was the higher occurrence of H.pylori, wich gastritis was detected in 72% among group 3. Differences in esophageal acid exposure and acid secretion, finally pattern of gastroduodenal lesions may account for differences in the clinical outcome of H.pylori infection. Also group 3 presented higher frequences of BE with 15.8% of cases and 3 of them had a dysplasia.
Clinical manifestation of group 4: We strongly refferred that 24-h esophageal pH monitoring is useful as diagnostic approach for establishing the severity of GERD. High degree of esophageal acid exposure related to patients of this group and determined the desynchronosis of circadian rhythm of intraesophageal and intragastric acidity. We considered that 24-h pH metry became one of chronophysiological method, its multilateral paramteres were reflected in diagnosis of GERD. The occurrence of H.pylori among the GERD patients closely related to peptic ulcer diesease, that reached up to 90% (x2=30.25, df 3, p<0.05).
According to clinical manifestations, depending on morphophysiological appearance of esophagus and stomach we suggest to divide GERD patients into 4 clinical forms: symptomatic GERD, independent RE, RE with combination of chronic gastritis, and RE associated peptic ulcer disease.
Судалгааны үр дүн:
1. ХУХСӨ-ий уеийн улаан хоолой, ходоодны бутэц зуйн онцлог.
ХУХСӨ-тэй 172 хүнээс 131 (76.1%) тохиолдолд уян дурангийн шинжилгээгээр сөөргөөт эзофагит (СЭ) илэрч, 41 (23.9%) тохиолдолд улаан хоолой болон ходоод, дээд гэдэсний салст бүрхүүлд уян дурангийн шинжилгээгээр өөрчлөлт ажиглагдсангүй. СЭ - ын үед ходоодны амсар дутуу хаагдах (65.6%), ходоодны шүүс сөөргөх (52.9%), өрцний улаан хоолойн нүхний ивэрхий (49.6%), БУХ (26.7%), хавьтлын цус алдалт (15.2%), салст бүрхүүлийн шарх сорвижин эдгэрч нарийсах (12.2%), улаан хоолой богиносох (6.8%) шинж тэмдэг ажиглагдсан. ХУХСӨ -тэй хүмүүсийн 71.8%д нь архаг гастрит, шархлаа өвчин дагалдаж байв. СЭ - ын идэвхижил нь дагалдаж буй ходоодны архаг эмгэгээс, ялангуяа ХДГШӨ-өөс хамааралтай байх ба тус шинжлүүлэгчдэд "С" ба "Д" зэргийн идэвхижилтэй СЭ 48.4% -д нь илэрсэн. ХУХСӨ - ий үед нугалуур хэсгийг хамарсан (63.9%), идэвхижилтэй ба шалбархайт (22.6% ба 37.1%) гастрит давамгайлж байлаа. ХУХСӨ - ий үед ходоодны архаг эмгэг ба Hp халдвар шууд, хүчтэй хамааралтай байх ба Hp нян 72-90% илэрсэн. БУх өөрчлөлт бүхий 29 тохиолдлыг дуран-эмэгг бүтэц зүйн шинжилгээгээр оношилсон. БУХ
2006 оны 04 (32 )
илрэл нь хавсарсан өвчнөес бус СЭ-ын идэвхижлээс хамаарч буй зүй тогтол нь БУХ нь СЭ-ын хүндрэлийг илтгэнэ гэж бид үзсэн.
2. ХУХСӨ-ий уеийн улаан хоолой, ходоодны рН орчны хоногийн хэмнэлийн онцлог ХУХСӨ-ий үед ихэнхи шинжпүүлэгчдэд улаан хоолойн рН орчин хоногийн үеүдэд янз бүрийн цараатай, дээд ба доод хэмжээнүүдийн хооронд хэлбэлзэх хэмнэлт зүй тогтол хадгалагдаж байсан. ХУХСӨ - ий үед Ун рН доод зааг 4.0-с буурч, хүчиллэг болох, дээд зааг 7.0-с хэтрэхгүй байх онцлогтой байсан. ХДШӨ хавсарн СЭ бүхий өвчтөнд хоногийн хэмнэлийн ерөнхий төрх алдагдах нь тод байлаа. ХУХСӨ -ий 1 ба 2 бүлгийн хүмүүст ходоодны рН орчны хэмнэлийн төрх хадгалагдаж, шүүрлийн ажиллагаанд өөрчлөлт илрээгүй. Ходоодны эмгэг хавсарсан ХУХСӨвчтөнд ходоодны рН орчны хэлбэлзлийн далайц ихэсч, хэмнэлийн цараа эрс өөрчлөгдөж байлаа. ХДГШӨ хавсарсан СЭ - ын үед ходоодны рН үзүүлэлтийн хэлбэлзэл жигд бус болж, хоногийн хэмнэл арилсан юм.
Дүгнэлт: ХУХСӨ - ий үеийн улаан хоолой ба ходоодны бүтэц, үйл ажиллагааны онцлогт тулгуурлан ХУХСӨ - ийг 1) шинж тэмдэгээр илрэх буюу дуранд өөрчлөлтгүй ХУХСӨ, 2) биеэ даасан СЭ, 3) СЭ ба гастрит хавсарсан, 4) СЭ ба ХДГШ өвчинтэй хавсарсан эмнэл зүйн хэлбэрүүд гэж ялган үзэх үндэслэлийг бид дэвшүүлж байна.
