Kirianchuk N. Features of development and clinical course of combined gastroesophageal reflux disease and chronic gastroduodenal pathology in children.

The dissertation contains a new decision of increasing the efficiency of diagnostics and prognosis of combined gastroesophageal reflux disease and chronic gastroduodenal pathology (CGDP) based on the study of clinical and paraclinical manifestations, indicators of the functional state of the stomach and duodenum, the level of zinc in the blood, the condition of the motor functions of the stomach, the presence of H.pylori, endoscopic and echosonographic signs of the condition of the mucous membrane and the sphincter apparatus of the stomach and duodenum, the development of the model for predicting the severity of GERD. It shows that the risk factors for the development of destructive forms of esophagitis in children with combined GERD and CGDP are the following: age 16-18 years, male sex, duration of the disease for more than 3 years, burdened obstetric history, psychotrauma, bad habits, as well as burdened heredity for esophageal diseases, gastric ulcer and duodenum. The features of the clinical course of combined GERD and CGDP pathology were considered. It was found that children with destructive esophageal lesions were significantly more likely to have extraesophageal symptoms. The results of endoscopic examination of the upper parts of the digestive tract with their combined lesion were described. It was found that the more pronounced inflammation of the stomach was significantly more often observed in children with signs of erosive esophagitis. The paper presents a new development of a non-invasive method for determining the severity of gastroesophageal (GER) and duodeno-gastric (DGR) reflux in the echosonographic study of the stomach and duodenum. New data on the correlation of acid-forming acid-neutralizing and motor functions of the stomach and their role in the development of destructive forms of esophagitis in children with combined GERD and CGDP was determined. It was shown that children with hyperproduction of hydrochloric acid significantly more often (p <0.05) developed hypokinetic dyskinesia of the stomach. It was found that the degree of esophageal mucosal lesion did not depend on H.pylori infection. The paper indicates that more than half of children with combined GERD and CGDP had a decreased level of zinc in the blood. It was found that the most pronounced decrease in the level of zinc in the blood was observed in children with destructive esophageal lesions. Risk factors for the formation of zinc deficiency in the combined pathology – mail sex, age 16-18 years, as well as the duration of the disease for more than 3 years. For the first, time a mathematical statistical model for predicting the severity of GERD against the background of CGDP