Mechanisms of formation of the gastroesophageal reflux disease and coronary heart disease comorbidity
Journal Title: Сучасна гастроентерологія - Year 2018, Vol 0, Issue 3
Abstract
Objective — to identify possible transnosological mechanisms for the formation of comorbidity of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD). Materials and methods. The study involved patients (n = 65) with GERD in combination with CHD: 54 men (83.08 %) and 11 women (16.92 %) aged 32 to 89 years; the mean age 61.57 ± 11.37 years. The laboratory-biochemical, clinical-instrumental and statistical methods were used during the study. Results. According to the anamnesis history, GERD duration varied 0.5 to 11 years (the mean duration 4.12 ± 2.25 years; median — 4 years); CHD duration ranged from 1 to 21 years; the average — 7.07 ± 4.61 years; the central trend (Me) — 6 years. All patients were divided into two groups: group I (n = 21; 32.31 %) consisted of subjects with non-erosive GERD and CHD; group II (n = 44; 67.69 %) included patients with erosive GERD and CHD. In both groups, women had an average lower cardiovascular risk (CVR) on different scales than men, and a higher percentage of associated 10-year survival, associated with modified risk factors (smoking, alcohol, body mass index, unhealthy diet, low physical activity, lipid metabolism). The dependence of severity obstructive sleep apnea (OSA) syndrome on the endoscopic form GERD (p = 0.0007) and dependence of level sleep disorders on clinical and morphological manifestations GERD (p = 0.0498) have been determined. The obtained data indicated the important transnosological mechanisms of formation of the GERD and CHD comorbidity: increased CVR and comorbidity level, changes in lipid spectrum and synthesis neurohormones, the presence of cardiac («cardiac mask») and pulmonary («pulmonary mask») manifestations, depressive and sleep disorders. Conclusions. The obstructive sleep apnea (OSA), as an insomnia variant, was established as a factor of the adverse course of GERD and CHD comorbidity. This is one of transnosological mechanisms that promotes the emergence of numerous organic and functional systematic violations. At the GERD and CHD comorbidity, the severity of insomnia and depression depends on the patient’s age, the CHD duration and level of body mass index (p < 0.05); at different forms GERD there are differences in the main diagnostic parameters of severity OSA; the OSA severity was associated with the endoscopic GERD form (p = 0.0007); there is a dependence degree of sleep disorders on the clinical and morphological GERD manifestations (p = 0.0498). The increase in the comorbidity degree is proportional to the higher probability of mortality (r = 0.782; p < 0.001); correction of the comorbidity indexes with CVR indexes allowed to determine more correctly the remote prognosis of combined disease and significantly improve the effectiveness of therapeutic and prophylactic actions.
Authors and Affiliations
G. D. Fadieienko, А. О. Nesen, О. О. Krakhmalova, O. V. Izmailova
Keywords
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- EP ID EP298431
- DOI 10.30978/MG-2018-3-7
- Views 125
- Downloads 0
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