Babak M. Gastroesophageal reflux disease and obesity: clinical and pathogenetic features, epidemiologic analisys and prognosys of natural history

The primary objective of the present dissertation was to study clinical, laboratory and instrumental characteristics of GERD in patients with overweight and obesity; to evaluate the effectiveness of treatment by a combination of proton pump inhibitor, prokinetic on the background normalization of body weight and develop predictive models of reflux esophagitis in this cohort of patients. Based on the results of this study, we conclude that adipocyte hormones influence on the development of GERD: LEP can provoke disease (rs = 0,4), AdipoQ has protective properties (rs = -0,4). There were revealed such predictors of aggressive clinical behavior GERD as LEP level in serum, sex of the patient In patients suffering from both GERD and obesity, an abrupt decrease of AdipoQ level associated with the progression of erosive damage to the esophagus (rs = -0,370). Intensive reduction of AdipoQ content in patients at the same time suffering from GERD and obesity is associated with progression of erosive damage of the esophagus (rs = -0,370). Progressive BMI increase in females with reflux esophagitis is accompanied by increased levels of LEP (p = 0.003) and is not associated with significant changes of AdipoQ concentration. The probability of erosive lesions of the esophagus in GERD patients with unchanged values of BMI is associated with an increase of LEP level and lowering of AdipoQ . The probability of erosive esophagus lesions in GERD patients with unchanged values of BMI is associated with increase of LEP concentration and decrease of AdipoQ. The appearance of erosive mucosal lesions of the esophagus is associated with a significant increase with the VF area (U = 160, p = 0,003), VF/SF (U = 115, p = 0.0001), and does not depend on the size of subcutaneous fat. Also grade of reflux esophagitis depends on the VF and VF/SF . Patients with GERD have single-nucleotide gene polymorphisms with carriage of rs2275738 ADIPOR1 and rs16928751 ADIPOR2. Significant differences in the prevalence of genotypes AA, AG, GG gene rs2275738 ADIPOR1, as well as the genotypes GG and GA + AA rs16928751 ADIPOR2 gene in patients with GERD have not been recorded (p> 0.05). Single nucleotide ADIPOR2 gene polymorphism rs16928751 is associated with the values of BMI , the size of SF, VF + SF . Probably, specified gen polymorphism can reduce the concentration of LEP (rs = -0,19 p = 0,08) and promote increase of VF.