The dissertation is devoted to the study of the current problem of internal medicine, namely the optimization of diagnosis and treatment of comorbid GERD and OSAS based on the study of melatonin, quality of life, oxidative stress and the development of a comprehensive scheme of pathogenetic therapy of this comorbid pathology.
Based on the analysis of literature sources, it is established that gastroesophageal reflux disease is currently an urgent problem of gastroenterology and therapy. Due to the wide prevalence, variety of clinical forms, frequent recurrence of GERD is now considered an epidemic of the XXI century. In recent years, the syndrome of obstructive sleep apnea / hypopnea is considered one of the factors that accompanies reflux disease and determines the features of its course. It has been established that OSAS, which is now considered a comorbid pathology, has a negative effect on GERD, as such conditions increase the frequency and duration of reflux from the stomach into the esophagus, which increases damage to the mucous membrane and increases the risk of Barrett's esophagus. Recently, many researchers have been paying special attention to oxidative stress and the pituitary hormone, melatonin. This biogenic amine, according to many researchers, inhibits the motor function of the gastrointestinal tract, blocking the action of cholecystokinin and other activators of the contractile ability of the muscles of this system, increases the protective properties of the epithelium by improving microcirculation, and regulates cell proliferation and increases the density of inter-epithelial contacts. However, the features of pathogenetic mechanisms of esophageal mucosa in patients with GERD as an isolated pathology and with concomitant OSAS and the role of melatonin, remain unclear, and the proposed standard treatment regimens are not always effective and do not promote long-term remission, which requires further research. All this prompted us to conduct a study aimed at studying the effect of QOL on melatonin content and parallel assessment of the factors of aggression and protection of the esophageal mucosa in patients with GERD without combined pathology and with concomitant mild OSAS, justifying the appropriateness of adding to the standard treatment with melatonin.
It is shown that the complex pathogenetic therapy of comorbid pathology of GERD with concomitant OSAS with additional melatonin in comparison with patients receiving standard therapy leads to a more reliable normalization of melatonin levels, diene conjugates, pH-metry, antioxidant protection and to indicators of norm.
In the study of patients with GERD without combined pathology and with concomitant OSAS on the basis of a comprehensive study of quality of life of patients and melatonin levels for the first time formulated the concept of the mechanism of inclusion of this relationship in the formation of local factors of esophageal mucosa. It is established that the trigger for the inclusion of melatonin as the main regulator of aggression and protection of the esophageal mucosa in the pathogenesis of GERD is a high probability of reducing QOL, physical health in patients with isolated GERD, and in patients with GERD with concomitant OSAS - indicators of psychologic QOL health.
Filed a new pathogenetic justification for the use of melatonin in the standard treatment system for patients with GERD, especially in the presence of OSAS.
It is proved that the appointment of melatonin as part of the standard treatment of patients with GERD, especially in the presence of concomitant OSAS, not only accelerates the increase in melatonin and normalization of the ratio of aggression and protection of the esophageal mucosa, but also significantly increases QOL.
The practical significance of the results obtained. It is proved that the developed complex of clinical and laboratory researches can be used as a marker of the forecast of a course of GERD and possibilities of formation in case of its presence OSAS.
It is established that a comprehensive study of QOL, melatonin levels, factors of aggression of the esophageal mucosa (pH-metry, DC concentration) and its protection (SOD content) allow to develop an optimal plan of treatment and prevention measures.
It was found that the observation of the dynamics of the spectrum of the studied indicators can be used to objectively assess the effectiveness of treatment.
