. Object of the study: the structural and functional state of the mucous membrane (MM) in the oesophagogastroduodenal area (OGDA) of patients with gastrooesophageal reflux disease (GORD) combined with chronic obstructive pulmonary disease (COPD). Purpose of the study: to increase the efficacy of treating patients with GORD in combination with COPD on the basis of revealed regularities in the formation of morphofunctional changes in the OGDA organs. Methods of the investigation: general clinical, functional, cyto-logical, histological ones, including morphometric, biochemical, statistical methods, polymerase-chain reaction method. Theoretical and practical results: the conducted studies made it possible to supplement the existing views on regularities in the formation of changes in the mucous membrane (MM) of the oe-sophagus (Oes), reveal their mechanisms in patients with GORD combined with COPD, and work out recommendations for their most optimum treatment. The practical value of the research con-sistsin the suggested method for assessing the expression rate of inflammatory changes in biological objects, therewith making it possible to improve the diagnosis of inflammatory processes in the Oes MM against a background of revealing correlations be-tween the compounds, which represent the prooxidant and anti-oxidant links in the oxidative homeostasis. It results in the ability to determine the expediency of using antioxidant remedies in the treatment of patients with the combined pathology. The postgraduate devised a technique for determining the character of oxidative stress, which is described in an information letter of the Ministry of Health of Ukraine “A technique of determining the character of oxidative stress and its clinical assessment in diseases of alimentary organs”, and realized its introduction. Novelty: results of the research broaden and deepen the knowledge of GORD combined with COPD. It was found out that the course of GORD and COPD in their combination was accompanied by a mutually aggravating influence, which was confirmed by a correlative dependence between the rate of revealing oesophagitis, inflammation and microhaemorrhagiae in the MM of bronchi, tracheobronchal dyskinesia, this fact testifying in favour of some pathogenetic unity of GORD and COPD. For the first time, morphogenetic regularities of changes in the Oes MM were found out in patients having GORD combined with COPD; these changes developed gradually, were observed as early as in an intact MM and manifested themselves by the thinning of the epithelial layer owing to a reduction of the superficial layer of degenerating epitheliocytes. Taking into account that it is the cells of this particular layer that ensure epithelial resistance to aggressive influences, this fact is prognostically unfavourable in the subsequent development of the Oes MM. It was proved that the progression of reflux oesophagitis in patients with a comorbid course of GORD and COPD was based on an insufficient provision of the nourishment of the Oes MM and an adequate proliferative activity of its epithelium. It is confirmed by a reduced amount of the connective tissue papillae, which accomplish a trophic function, and their more rarified loca-tion, as well as by the thinning of the cambial area of the epithelium in a hypertrophy of the layer of degenerating epitheliocytes, which are rejected. It was found out that morphological changes in the OGDA MM were supported by the action of aggressive factors of the stomach MM against a background of suppression of its resistance, which is augmented by disorders in the processes of collagen formation, caused by prevalence of collagen degradation over its synthesis. For the first time in GORD patients with COPD, the types of an individual response of the antioxidant link of the oxidative homeostasis to a superfluous formation of lipid peroxidation products were formed and their part in the development of structural disorders in the OGDA MM was revealed (Declaration Patent of UkraineNo. 20538 UA, МПК (2006) G01N 33/48 dated 15.01.2007). It was proved that the hyporeactive type of response of the antioxidant system (AOS) with an insufficient prooxidant link of the oxidative homeostasis was accompanied by the most severe lesion of the OGDA MM up to its erosion along the whole upper portion of the alimentary canal, an insufficient ability of the OGDA MM to reparation and a significant reduction in the resistance of the gastric MM. It points out that in case of the hyporeactive type of AOS response there is a decrease in the ability to mobilize potential reserves of the functioning structures, thereby leading to a disorder in the process of their restoration and ensuring the formation of new structural-functional states. A differential approach to treating patients with regard for the revealed regularities in the formation of morphofunctional changes in the OGDA organs made it possible to reduce the rate of revealing the hyporeactive response of the AOS to one-sixth and restore the correlation between the activity of the pro- and antioxidant links of the oxidative homeostasis in 42.1 % of patients, to eliminate the gastrooesophageal reflux in 80.7 %, to restore or improve the morphological state of the OGDA organs and the clinical state of the patients. Degree of introduction: the suggested methods of diagnosis were introduced in the work of the Department of Gastroduodenal Dis-eases of the Institute of Gastroenterology (Academy of Medical Sciences of Ukraine), the Therapy Department of Dnieprodzerz-hinsk City Hospital No. 9, the Gastroenterology Department of Hospital No. 6 of the City of Dniepropetrovsk, the Therapy De-partment of Dniepropetrovsk City Hospital No. 7, the Department of Anaesthesiology and Resuscitation of Dniepropetrovsk City Hospital No. 16, the Therapy Department of Dniepropetrovsk City Hospital No. 11, as it is confirmed by corresponding acts on introduction. Results of the thesis are used in the teaching process of the Department of Faculty Therapy of Odesa State Medical University (the Ministry of Health of Ukraine), the City of Odesa. Sphere of application: medicine, gastroenterology departments.
