Izmailova O. Improvement of the treatment of patients with gastroesophageal reflux disease and concomitant coronary artery disease: correction of disorders of melatonin synthesis and sleep disorders.

The dissertation is devoted to improving the treatment of patients with gastroesophageal reflux disease (GERD) and concomitant coronary artery disease (CAD), allowing a positive effect on symptoms of insomnia, obstructive sleep apnea (OSA), anxiety and depressive disorders and melatonin levels, improve blood supply to the esophagus and the clinical symptoms of GERD, as a whole. It was found that insomnia occurs in 61.54% and OSA occurs in 73,84 % of patients with GERD and CAD сomorbidity and is associated with age, the duration of CAD, body mass index and the severity of GERD. Worsening of the dopplerographic parameters of blood flow in the arteries supplying the lower esophageal sphincter was observed and significant decrease in melatonin levels was found. An association between melatonin levels and clinical symptoms and endoscopic form of GERD, the degree of reflux esophagitis and the severity of OSA was also detected. A method of diagnosing a form of GERD was proposed, which can be used to monitor the disease. It is proved that the basic therapy for GERD and CAD should be united with melatonin treatment and life-style modification. This leads to a significant improvement of state of patients.