Ischemic heart disease (IHD) continues to be one of the most common causes of disability and mortality of the population. At the same time, the prevalence of diseases which can mimic and significantly complicate the diagnosis of IHD, such as erosive-ulcerative pathology of GI tract, especially gastroesophageal reflux disease (GERD), is on the rise.
Moreover, endothelium plays an important part in the development of the atherosclerotic changes in the vascular wall, which are at the heart of both of these diseases. At the same time as the atherosclerotic changes, fibrous injury of the vascular wall plays a very important part. Galectin-3 (G-3) can be used as a marker of fibrous injury. Galectin-3 is a primary activator of cardiac fibrosis; it is highly expressed in fibrous tissues and its level is increased in chronic inflammatory processes. The level of Galectin-3 is correlated with risk factors of cardiovascular diseases linked to chronic inflammatory conditions. R. Dong et al. (2018) showed that G-3 can be utilised to diagnose not only cardiovascular diseases, but also other pathologies accompanied by inflammation and fibrosis, in particular GI tract conditions.
Studying the characteristics of motor-secretory esophageal disorders, formation of pathological gastroesophageal reflux and its clinical progression as a “cardiac mask” is also relevant for the people suffering from this comorbid pathology. Considering that both of these pathologies, both separately and in combination, cause not only functional and organic changes in a person’s body, but also deterioration of overall psychosomatic status, quality of life assessment in these patient is also important.
In the thesis, based on analysis of 110 patients with IHD with concomitant gastroesophageal reflux disease, we conducted a complex analysis of the factors affecting the development of GERD in patients with IHD, we have identified the most informative changes of levels of indicators of the functional status of endothelium (stable nitric oxid metabolites and ET-1), galectin-3, central hemodynamics of major vessels and regional blood flows, motor-secretory dysfunction, quality of life in the patients with IHD depending on the course of concomitant GERD, and we have established a correlational dependency between these indicators.
We have enhanced the understanding of the role of endothelial dysfunction in development of GERD with IHD in the background, confirmed by dependency between the levels of NO2 and NO2 + NO3, ET-1. We have established that in patients with IHD with concomitant GERD the level of stable nitric oxide (NO2, NO2 + NO3) metabolites is significatly lower (p < 0.001) than the level in both patients with IHD without the concomitant pathology and in the control group. At the same time, in patients with conocomitant pathology a significantly higher (p < 0.001) level of ET-1, in comparison to both the control group and the patients with IHD without concomitant GERD, is found. The findings indicate stronger endothelial dysfunction in the patients with concomitant course of these diseases.
Additional findings on the state of major vessels and regional blood flow in patients with IHD with concomitant GERD and its significance in the development of comorbid pathology. In patients with concurrent IHD and GERD, in comparison with patients with IHD without a concomitant pathology and control group, we note a significant decrease (р < 0,001) in rate of BA diameter enlargement ofter reactive hyperemia test, as well as significant decrease (р < 0,05) of CT diameter and increase of blood flow speed in the vessel, showing a more pronounced endothelial dysfunction in comorbid conditions.
We have conducted an in-depth analysis of quality of life using the SF-36 Health Survey in the patients with concomitant IHD and GERD. In the patients with IHD with concomitant GERD the assessment of their quality of live showed a significant deterioration of overall psychosomatic status due to and increased severity of the clinical course of comorbid pathology; we have found a significant decrease (p < 0.001) of the assessment numbers in both PH and MH scales.
As an additional method of early diagnosis of GERD in the patients with IHD we propose an algorithm, which includes the measurement of three parameters: NO2, NO2 + NO3 and ET-1: at levels of NO2 < 1,37 mcmol/l, NO2 + NO3 < 22,7 mcmol/l and ET-1 > 2,4 pmol/l the probability of existing GERD reaches 95 % (p < 0.001). Measurement of BA diameter after reactive hyperemia test (D > 4.9 mm) and CT diameter (D < 0.89 mm) have a sufficient prognostical value of probability of comorbid development of IHD and GERD. The alignment of positive changes in parameters of the functional state of endothelium and parameters of the functional state of the GI tract is the evidence of their close pathogenetic link.
