Trukhalska V. Optimization of diagnostics and treatment of gastroesophageal reflux disease in infants.

The thesis is devoted to theoretical substantiation of a new approach in solving the actual scientific problem - optimization of early diagnosis and treatment of gastroesophageal reflux disease (GERD) in infants by indicating factors, clinical course, detecting the motor esophageal dysfunction, genetic aspects of disease development, management of algorithm of staged diagnosis and improvement of complex treatment with the help of proton pump inhibitors drugs. There was found that the important factors of GERD risk are the following: prematurity (OR 3.45), diseases of the esophagus and stomach in family history (OR 13.38), mitral valve prolapse and other connective tissue dysplasia in children's parents (OR 9.49). It was proved that the most severe course of the disease is observed in children-homozygous carriers of gene COL3A1 with flat curve of weight gain (OR 42.75), a "wet pillow" symptom (OR 15.55), belching (OR 14.40). So, examination of gene COL3A1 should be conducted for children with GERD and signs and/or family risk of connective tissue dysplasia. There is elaborated algorithm of early staged diagnosis of GERD, which lessens use of invasive diagnostics methods and includes: detection of risk groups for GERD among infants (7 points and higher according to the results of reflux-questionnaire), conducting FEGDS for children of risk group; 24-hour pH-metria for children with digestive dysfunction by the FEGDS results, extra-esophageal GERD signs and carrier of homozygous mutation of gene COL3A1. There is proved efficacy of drug of proton pump inhibitors in complex of GERD management in infants.