Romash I. Peculiarities of the course and treatment of gastroesophageal reflux disease in patients with the syndrome of undifferentiated connective tissue dysplasia

The dissertation is devoted to the peculiarities of the course and treatment of gastroesophageal reflux disease in patients with the syndrome of undifferentiated connective tissue dysplasia. For the first time it was determined that such phenotypic signs of UCTD as dysphagia, Raynaud's phenomenon, arthralgia, unmotivated weight loss, skin rashes, ulcers of the oral mucosa, proximal muscle weakness, are observed significantly more often in patients with GERD in combination with UCTD, as in patients with GERD without comorbidities, and their frequency correlates with the severity and duration of GERD. For the first time it was found that 88.0 % of patients with comorbidity of GERD and UCTD had various abnormalities in the development of internal organs, while in patients with GERD without concomitant pathology, they were diagnosed only in 6.6 % of the investigated. For the first time it was proved that in patients with combined pathology the number of gastroesophageal refluxes with pH <4 was in 1.4 times more frequent than in patients with GERD without changes in the connective tissue. There is a direct correlation between the severity of UCTD and the number of refluxes with pH <4 lasting more than 5 minutes. For the first time the nature of micro- and macro-element disorders in patients with a combination of UCTD and GERD was studied and it was also determined a decrease in magnesium concentration, calcium, manganese and an increase in copper, zinc and iron with a simultaneous increase in matrix metalloproteinase-9 activity and an increase in oxyproline in the blood and urine. There was a more marked increase in the concentration of ghrelin in blood plasma in patients with comorbidity of GERD and UCTD and a slightly less significant increase compared in healthy people with GERD. In patients with comorbidity of GERD and UCTD it was detected an increase in the level of prostaglandins E2 in the blood by 2.46 times with a simultaneous decrease in prostaglandins F2α by 1.54 times, while in GERD without connective tissue damage such divergent changes were less marked (increase in PGE2 in 1.3 times and a decrease in PGF2α - 1.2 times), that indicates a decrease in the tolerance of its mucosa to damaging factors and, possibly, the effect on the tone of the circular muscles of the LES (decrease under the influence of PGE2 and increase under the action of PGF2α). It was found that the increase in circulating ghrelin levels is positively correlated with the level of PGE2 and negatively - with the level of PGF2α in the blood.For the first time, the viability of including magnesium-B6 and calcium-D3-nicomed to the standard therapy of GERD on the background of UCTD was scientifically substantiated. Key words: gastroesophageal reflux disease, syndrome of undifferentiated connective tissue dysplasia, micro- and macro-elements, prostaglandins E2 and F2α, ghrelin, intragastric pH-monitoring. Branch – medicine.