Object of the study: refractory gastro-oesophageal reflux disease (GORD) associated with adiposity. Purpose of the study: optimization of the diagnosis and treatment of refractory GORD in adiposity patients with regard to the exogenous and endogenous factors, which prevent complete recovery of the patients. Methods of the investigation: clinical, anthropometrical, biochemical, functional (daily pH monitoring, gastric intubation with the study of parameters of the functional state of the stomach [S], assessment of the motor-evacuation function [MEF] of S by sonoscopy), morphological (with help of oesophagogastroduodenoscopy and histological analysis of biopsies), statistical. Theoretical and practical results: the necessity of assessing the state of MEF of S in adiposity patients with signs of refractory GORD was established. The algorithm of treating patients, described in methodological recommendations of the Ministry of Health of Ukraine “Refractory gastro-oesophageal reflux disease: causes of its development, the diagnosis and treatment”, is grounded and promising for an increase in the efficacy of the patients’ treatment. Novelty: 3 most typical groups of exogenous factors, which prevent complete recovery of patients with refractory GORD associated with adiposity, were revealed: the patients’ violation of their doctors’ recommendations, the use of nonsteroid anti-inflammatory drugs (NSAID), and hard physical labour. The use of the ultrasonography method for studying the motor function of S was proved, thereby making it possible in patients with refractory GORD, associated with adiposity, to reveal an anatomical incapacity of the pylorus by the pyloric index, a disturbance in the peristaltic activity of the antral portion (AP) of S, a retrograde throwing of the duodenal contents into the gastric cavity with the determination of the number and duration of duodenal reflux episodes. For the first time by an integral index, the biliary reflux index, it was proved that in adiposity the impairing action ofthe duodenal reflux on the mucous membrane (MM) of S was more influential than in patients with the normal body weight and manifested itself by atrophy, sclerosis of the MM plate proper, hyperplasia of the integumentary-foveal epithelium of MM of the body and AP of S, intestinal metaplasia and dysplasia of MM in the acid-producing area of S. It was found out that glycoconjugates of primary bile acids were the most influential components of the reflux contents, and that their level correlated with the body weight index, reflux-oesophagitis degree, presence of erosive changes in the oesophagus. Structural changes in MM of the oesophagoduodenal area of patients with refractory GORD, associated with adiposity, were supported by an imbalance in the antioxidant link of the oxidative homeostasis system. For the first time in adiposity patients, a differentiated approach to the treatment of refractory GORD was substantiated, with regard to the revealed exogenous factors, which prevent complete recovery of the patients, the impairing action of the reflux contents components, the functional disturbances of S, and with regard to the phases in the lipid metabolism reconstruction. Degree of introduction: the suggested methods of the diagnosis and treatment were introduced into the work of the Diagnostic Department and the Department of the Stomach and Duodenum Diseases of the Institute of Gastroenterology of the Academy of Medical Sciences of Ukraine, the Therapeutics Department of Dnipropetrovsk City Hospital No. 18, the Gastroenterology Department of Dnipropetrovsk City Hospital No. 11, the Therapeutics Department of Dnipropetrovsk City Hospital No. 6, the Endocrinology Department of Dnipropetrovsk Multi-Type City Hospital No. 4, the Gastroenterology Department of Cherkasy Regional Hospital, as it is confirmed by the corresponding acts on introduction. Sphere of application: medicine, gastroenterology departments.
