The dissertation of Ihnatko O.I. “Clinical and pathogenetic features of the course of chronic obstructive pulmonary disease in comorbidity with gastroesophageal reflux disease, optimization of diagnosis and treatment” is devoted to improving the effectiveness of diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in combination with gastroesophageal reflux disease (GERD). The paper examines the influence of GERD on the clinical course of COPD, indicators of spirometry, systemic inflammation, levels of prostaglandin E2 and endothelin-1 (ET-1), psychological status and quality of life of patients, taking into account the smoking index.
In the dissertation, it was shown for the first time that in the presence of GERD in patients with COPD, even beyond the exacerbation stage, there was a more pronounced increase in acute-phase indicators compared to patients without GERD, in particular, a more pronounced increase (by 3 times) in the level of IFN-γ and the ratio between IFN-γ/IL-4, which indicates higher activity of systemic inflammation and immune defense stress. It is also proved the aggravating effect of GERD on the clinical course of COPD, which is characterized by a significantly higher (p<0.05) frequency of exacerbations of COPD and hospitalizations, hospital stay duration among patients with a combination of COPD and GERD, compared to COPD, and the onset of exacerbations was associated with an increase of the gastrointestinal symptoms (increased heartburn and belching with acid) and subsequent worsening of respiratory symptoms.
Added scientific data on the relationship between spirometry indices and systemic inflammation in patients with COPD and GERD, in particular, a more pronounced inverse correlation between spirometry indices (forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), index Gaenslar (FEV1/FVC) and the levels of individual inflammatory mediators (CRP, IL-6, TNF-α, IFN-γ) in comorbid patients compared to the COPD group, which emphasizes the aggravating effect of GERD on the relationship between spirometry indices and systemic inflammation in patients with COPD.
In patients with COPD, comorbid with GERD, in comparison with COPD, the data on increased ED, in particular according to the indicators of prostaglandin E2 and ET-1, which are an unfavorable prognostic sign of both COPD and GERD progression, along with high levels of other inflammatory mediators, the influence of smoking and frequent use of inhaled or oral glucocorticoids.
The treatment scheme of patients with COPD in combination with GERD was improved by additional prescription of the cytoprotective drug rebamipide to the standard antireflux therapy together with basic treatment of COPD. It was established that the prescription of rebamipide has a positive effect not only on the clinical course of GERD, but also contributes to the elimination of cytokine imbalance, in particular, it allows to achieve a reliable decrease in the levels of TNF-α and IL-6, and also reduces the dysfunction of the endothelium by the level of prostaglandin E2 and ET-1, contributing improving the course of both COPD and GERD with an increase in quality of life indicators according to the European Quality of Life 5 Dimensions (EQ-5D) questionnaire.
In order to prevent exacerbation of COPD, taking into account the high frequency of GERD and its aggravating effect on the clinical course of COPD, a targeted survey of patients to identify gastroenterological complaints is recommended. The expediency of determining prostaglandin E2 and ET-1 as additional markers of both COPD and GERD progression is also recommended.
In view of the obtained results, the thesis has an important practical significance, since the proposed modified treatment with the addition of the cytoprotective drug rebamipide to the standard therapy of COPD in comorbidity with GERD helps to increase the effectiveness of treatment of patients with COPD in the presence of GERD.
Key words: chronic obstructive pulmonary disease, gastroesophageal reflux disease, comorbidity, systemic inflammation, Helicobacter pylori, rabeprazole, rebamipide.
