Dissertation is initiated to study the clinical manifestations of gastroesophageal reflux disease (GERD), endoscopic and morphological changes in the esophageal mucosa, esophageal pH-monitoring in patients with type 2 diabetes mellitus (DM), depending on the degree of compensation of carbohydrate metabolism in the dynamics of standard treatment (pantoprazole + mozaprid ) or standard treatment + cytoprotective agent rebamipide for patients with GERD and type 2 DM. As a result of a comprehensive survey 107 GERD patients (41 men and 66 women) found that symptoms of GERD in patients with DM are characterized by a variety of clinical and laboratory data. Typical esophageal complaints of GERD (heartburn 29,9 %; p 0,01; a sour taste in the mouth 10,4 % p 0,05; regurgitation acid 9,0 %, p 0,01) is rarely appear in patients with DM; atypical extraesophageal complaints is dominated (nausea 19,4 %, p 0,05; regurgitation of food 13,4 %; p 0,05; cardialgia attacks 41,8 %, p 0,01; hoarseness 17,9 %, p 0,05) in comparison with GERD without DM. The erosive forms of GERD were more often diagnosed in patients with GERD and DM (reflux esophagitis B: 38,8 %, p 0,01; hyperemia of the lower third of the esophagus: 22,4 %, p 0,05) as opposed to patients with isolated GERD. Some gender characteristics have been identified: RE A and B usually diagnosed in men with DM; RE C frequently detected in women with DM. In the morphological study found that the degenerative changes, keratosis and acanthosis (p <0,001), as well as the infiltration of subepithelial space (p < 0,05) more common in patients with GERD and DM compared with isolated GERD. In patients with GERD and type 2 DM occur expressed esophageal dysmotility: reflux become more numerous and lengthy, occur mainly at night, which can lead to more severe gastroesophageal reflux (index DeMeester 96,53 ± 1,02 versus 87,01 ± 1,11; p < 0,0001) according esophageal pH-monitoring. In patients with GERD and DM recorded positive correlation between glucose levels and the time of pH < 4 (fasting glycemia: ? = 0,473, p < 0,01; postprandial glycemia: ? = 0,244, p < 0,01) as well as between HbA1c and the time of pH <4 (? = 0,564, p < 0,01), HbA1c and severity of reflux (? = 0,262, p < 0,05). The obtained results demonstrate that type 2 diabetes causes change in symptoms, endoscopic and histologic manifestations of GERD. In patients with GERD and DM receiving only standard therapy, clinical, endoscopic, morphological, and pH-metric findings of GERD were stopped more slowly and leveled with varying degrees of confidence (from p < 0,05 to p < 0,001) after 12 weeks of treatment, in contrast to patients treated with cytoprotective agent rebamipide. The endoscopic investigations, performed 4 weeks after the treatment, have established that the number of patients without esophageal lesions in the group of triple therapy was twofold greater than in the group treated with pantoprazole plus mosapride. Healing rates in patients with GERD and DM treated with rebamipide approaching the level in patients with isolated GERD; a positive trend appears already in the 4th week of treatment. The therapeutic efficacy of the treatment of GERD was higher in patients with DM treated with cytoprotective agent: 4-week course rebamipide was associated with complete healing of erosions in 35,1 % cases, 12 weeks - with the preservation state non-erosive esophageal mucosa 48,6 % cases compared with no cytoprotective therapy (respectively, 10,0 % and 20,0 %; in both cases, p < 0,05).
