The dissertation deals with the solution of an actual problem in internal medicine: that is, optimization of diagnosis and treatment of gastroesophageal reflux disease with insomnia and concomitant neurocirculatory dystonia on the basis of studying the levels of melatonin, serotonin, gastrointestinal status, autonomic dysfunction, psychosomatic changes, life and sleep quality, their connections and transformations under the influence of different treatment regimens.
Gastroesophageal reflux disease (GERD) is the most common pathology in the structure of acid-dependent diseases and is worldwide, which makes it relevant for modern gastroenterology. The disease mainly affects young and working-aged people. Along with this, the number of patients with comorbid pathology, among which there is neurocirculatory dystonia (NCD), is increasing. Insomnia is a frequent companion of both diseases.
Melatonin and serotonin hormones have an important role to play in the mechanisms of GERD, NCD and insomnia. However, the effect of the melatonin-serotonin system on the gastrointestinal tract, autonomic nervous system, psychosomatic status and quality of life and sleep in this comorbid state and comorbid state remains incompletely studied. It necessitated this study, which is aimed at optimizing the treatment of gastroesophageal reflux disease with insomnia and concomitant neurocirculatory dystonia. Such treatement is based on the study of levels of melatonin, serotonin, gastrointestinal tract, autonomic dysfunction, psychosomatic changes, life and sleep quality, their connections and transformations under the influence of different treatment regimens.
For this purpose, a comprehensive examination of 110 patients with non-erosive form of GERD and insomnia was performed. Depending on the presence of concomitant neurocirculatory dystonia in patients, 2 observation groups were formed. The first (main) group included 70 patients with GERD with insomnia and concomitant NCD, whilst the second group (comparison) consisted of 40 patients with GERD and insomnia without concomitant pathology.
For treatment, each group of patients was divided into 2 groups. Group 1 included 35 patients with GERD with insomnia and concomitant NCD, who received NERD therapy according to the order of the Ministry of Health of Ukraine № 943 on 31.10.2013 (proton pump inhibitor – omeprazole 20 mg twice a day and prokinetic – domperidone 10 mg three times a day, both drugs were taken 40 minutes before meals for 4 weeks).
Group 2 included 35 patients with GERD with insomnia and concomitant NCD, who, in addition to standard therapy, for 3 weeks received additional melatonin at a dose of 3 mg once a day, at night, half an hour before the scheduled sleep. Group 3 included 20 patients with GERD with insomnia who received standard therapy. Group 4 included 20 patients who, in addition to standard therapy, received additional melatonin.
In patients with GERD with insomnia, increased aggression of gastric juice predominates (p <0.05). Decreased melatonin level and increased serotonin level are associated with impaired motility and secretion in patients of both groups.
Imbalance in the melatonin-serotonin system has a significant impact on the psychosomatic state and quality of life. In patients of both groups, a correlation was found between PHQ-9 and melatonin (r = -0.46, r = -0.34, at p <0.05, respectively), serotonin (r = 0.52, r = 0.38, at p <0.05, respectively); between personal anxiety and melatonin (r = -0.44, r = -0.33, at p <0.05, respectively), serotonin (r = 0.42, r = 0.35, at p <0, 05, respectively), between reactive anxiety and melatonin (r = -0.38, r = -0.39, at p <0.05, respectively), serotonin (r = 0.34, r = 0.33, at p <0.05, respectively); between the Physical Health of quality of life and indicators of melatonin (r = 0.47, r = 0.44, at p <0.05, respectively), serotonin (r = -0.44, r = -0.41, at p < 0.05, respectively), between the Mental Health of quality of life and melatonin (r = 0.53, r = 0.46, at p <0.05, respectively), serotonin (r = -0.49, r = - 0.37, at p <0.05, respectively).
3-week addition of 3 mg of melatonin to the standard therapy of patients with GERD with insomnia and concomitant NCD and patients with GERD with insomnia leads to a more effective reduction of autonomic dysfunction, normalization of sleep, reduces psychosomatic manifestations and improves quality of life (p <0.05 for all indicators), in comparison with patients who were treated only according to the standard scheme.
Thus, the study proved that in patients with GERD with insomnia and concomitant NCD the imbalance of the melatonin-serotonin system affects not only the quality of sleep, but also the course of GERD, autonomic nervous system, psychosomatic state and quality of life. The inclusion of melatonin in the treatment regimen of these patients improved gastrointestinal status, autonomic, psychosomatic condition, quality of sleep and life.
