The dissertation is devoted to finding ways to solve the current problem of internal medicine - optimization of diagnosis and treatment of comorbid GERD and hypothyroidism due to AIT based on the study of thyroid hormones, psychosomatic status, quality of life, regional circulation, motor-secretory function of the gastrointestinal tract and development on the basis of this complex scheme of pathogenetic therapy of this comorbid pathology. After all, the problem of gastroesophageal reflux disease (GERD) remains one of the most relevant in modern gastroenterology. In recent decades, there has been a tendency to increase in the incidence of GERD especially among young people. Symptoms of GERD occur in almost half of the adult population. The main symptom of GERD - intermittent heartburn, which significantly reduces the quality of life, noted in up to 40% of residents of industrialized countries. According to statistics, worldwide prevalence of GERD is from 8 to 33% depending on the country. However, the real prevalence of GERD in the population has not been studied enough due to the low rate of medical treatment seeking, frequent asymptomatic course as well as the course of the disease under masks, the so-called "esophageal" manifestations.
At the same time, the number of patients with GERD with combined pathology is growing. One such disease is autoimmune thyroiditis (AIT). AIT - is one of the most common diseases of the thyroid gland. Autoimmune inflammatory process in the thyroid gland leads to the constant production of autoantibodies to thyroperoxidase or thyroglobulin and further leads to permanent destruction of the thyroid gland with the subsequent development of hypothyroidism. Early diagnosis of AIT allows to timely treatment and maintains thyroid function.
Both of these diseases have several common pathogenetic mechanisms, the main of which are thyroid hormones that regulate motility and secretion of the gastrointestinal tract. The comorbid course of these pathologies aggravates and modifies the clinical picture each other.
To achieve this goal, a comprehensive examination of 105 patients with non-erosive form of GERD was performed. The mean age of the patients was (20.29 ± 0.17) years. The first group included 65 patients with GERD with concomitant AIT, among whom there were 55 (84.6%) women and 10 (15.4%) men. The mean age of patients in the first group was (20.31 ± 0.21) years. The second group included 40 patients with non-erosive form of GERD without concomitant pathology (mean age 20.25 ± 0.27 years), 33 (82.5%) of whom were women and 7 (17.5%) were men. The control group was formed of 20 practically healthy individuals who corresponded in age and sex to patients from the main group and the comparison group.
It was established that in patients with comorbid GERD and AIT as well as in patients with isolated GERD the first place is occupied by complaints of heartburn, but in patients with comorbid GERD and hypothyroidism due to AIT significantly more pronounced symptoms of GERD were detected, that confirmed by GERD-Q questionnaire (p<0.05), more pronounced psychosomatic disorders were detected, which was manifested in an increase in anxiety (Sheehan's self-esteem scale) and a significantly lower quality of life (GIQLI index) (p <0.05) compared with patients with isolated GERD.
It is established that in patients with GERD with concomitant AIT there is an effect of thyroid hormones on the clinical manifestations of GERD, which is confirmed by more pronounced GERD symptoms, psychosomatic disorders and a lower level of quality of life in patients with comorbid GERD and AIT compared with patients with isolated GERD, which have a positive trend as the level of thyroid hormones normalizes.
Reliable correlations were established between the severity of clinical manifestations of GERD (GERD-Q questionnaire), psychosomatic disorders (Sheehan Patient-Rated Anxiety Scale), quality of life (GIQLI index), indicators of motor-evacuatory and secretory function of the esophagus and stomach, state of regional blood circulation and level of thyroid hormones in patients with isolated GERD and GERD with concomitant AIT.
It was shown that complex pathogenetic therapy of comorbid pathology of GERD and AIT with additional prescription of selenite sodium in comparison with patients receiving standard therapy leads to more reliable normalization of thyroid hormone levels, reduction of antibodies to thyroperoxidase, elimination of clinical manifestations, normalization of motor-secretory disorders and regional blood circulatory, mental circulation and increasing of life quality.
