NON-INVASIVE METHODS OF DIAGNOSTICS OF GASTRO-ESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH ISCHEMIC HEART DISEASE.

OBJECTIVE: The aim: To determine the diagnostic value of non-invasive methods of GERD diagnosis based on questionnaire data and a diagnostic test with a proton pump inhibitor (PPI) with Rabeprazole in patients with coronary heart disease (CHD). PATIENTS AND METHODS: Materials and methods: 90 patients were under observation, namely, 68 patients with coronary heart disease with concomitant essential arterial hyperten¬sion (EAH), 6 patients with coronary artery disease + arrhythmias, and 18 - others diseases. All patients were surveyed according to the GerdQ questionnaire, followed by PPI testing with Rabeprazole, and body mass index (BMI) was calculated for all the patients. A BMI of 18.5-24.9 kg/m2 was considered as normal body weight, and a BMI > 24.9 kg/m2 was considered overweight. RESULTS: Results: Based on the results of the questionnaire, it was established that the most common complaints typical for GERD were noted by patients with CHD in combination with EAH. There were 48 of such patients and, depending on BMI, they were divided into 2 groups: 1st group (n=14) - patients with CHD+EAH+GERD with normal body weight and 2nd group (n=34) - overweight patients with CHD+EAH+GERD. In patients of group 1, typical symptoms of GERD prevailed (in 71.4% of patients), and in patients group 2, the distribution of typical and extra-esophageal symptoms did not differ significantly (52.9% vs. 47.1%). Among the extraesophageal manifestations, pain behind the sternum (in the projection of the esophagus) was significantly more often recorded in patients of group 1, and rhythm disturbances in patients of group 2 (43.8% and 75.0% of patients, respectively, p<0.05). The results of the GerdQ questionnaire showed a direct relationship between GERD, body weight and symptom score. Patients with GERD+normal body weight had a mean score of 6 for classic gastroesophageal reflux symptoms, while patients with GERD+increased body weight had a mean score of 7. The sensitivity of the questionnaire was 78.7%, and the specificity - 92.9%. According to the PPI test, in the 1st and 2nd groups, already in the first three days, 28.5% and 23.5% of patients noted the disappearance of heartburn and after 10 days - 85.7% and 64.7%, respectively. Over the entire period, that is, after 14 days of observation, 85.7% of patients in the 1st group and 73.5% in the 2nd group noted improvement. CONCLUSION: Conclusions: It has been established that questionnaires based on the GerdQ questionnaire followed by a PPI test with Rabeprazole in patients with coronary heart disease combined with essential arterial hypertension have a high diagnostic value and can be used for early diagnosis and effective treatment of GERD.

ASSOCIATION BETWEEN SERUM ZINC, COPPER AND SELENIUM LEVELS AND THE DEGREE OF LIVER DAMAGE IN PATIENTS WITH CHRONIC HEPATITIS C.

OBJECTIVE: The aim: To evaluate the content of trace elements Zn, Cu and Se in blood serum and their relationship with viral load and the degree of liver fibrosis according to the results of the FibroMax test in patients with CHC. PATIENTS AND METHODS: Materials and methods: 62 outpatients with a verified diagnosis of CHC were under observation, in which serum Zn, Cu and Se levels, viral load and degree of liver fibrosis were determined according to the FibroMax test. RESULTS: Results: HCV 1b genotype was detected in all patients. The proportion of patients with a high viral load was 32%, with a low viral load - 68%. In 19% of patients, the level of Zn was below normal, and the levels of Cu and Se were within the reference values. The proportion of patients without fibrosis was 32%, 16% had minimal fibrosis, 40% had moderate fibrosis, 8% had progressive fibrosis, and 3% had severe fibrosis. 68% of patients had active inflammation of various degrees, liver steatosis - 65%, non-alcoholic steatohepatitis - 48%, inflammation caused by alcohol consumption was absent. No statistically significant difference was found in serum trace element levels and viral load (p>0.05). A weak negative correlation between the level of Zn and the degree of fibrosis (ρ=-0.340, p=0.007) and a negligible negative correlation between the level of Zn and inflammation activity (ρ=-0.286, p=0.024) were revealed. Patients with fibrosis grade ≥F2 had lower Zn levels compared to patients with fibrosis ≤F1 (0.607 (0.540, 0.691) mg/l vs. 0.716 (0.593, 0.875) mg/l, p=0.01), and when comparing there was no difference in Cu and Se levels (р>0.05). CONCLUSION: Conclusions: Thus, there is a relationship between the level of Zn in blood serum and the degree of liver damage in patients with CHC, which indicates the prospects for further research.

DYNAMICS OF FIBROTIC CHANGES IN THE LIVER AFTER THE SUCCESSFUL ERADICATION OF HEPATITIS C VIRUS IN PATIENTS WITH NAFLD.

OBJECTIVE: The aim: To assess the dynamics of serum levels of angiopoietin-2 and transforming growth factor-ß1 in patients with chronic hepatitis C (CHC) with concomitant nonalcoholic fatty liver disease (NAFLD) after successful DAAs. PATIENTS AND METHODS: Materials and methods: 82 patients with CHC were examined, of which 56 were diagnosed with NAFLD and increased body weight. Ang-2, TGF-ß1, leptin, adiponectin, and the degree of liver fibrosis were determined for all participants. The patients were divided into groups: 1 gr. (n=23) - CHС + increased body weight + hepatic steatosis, 2 gr. (n=33) - СНС + increased body weight + nonalcoholic steatohepatitis, 3rd gr. (n=26) - CHC. All patients received DAAs for 12 weeks. RESULTS: Results: From 82 patients F3-4 had 31 people, F1-2 - 25, F0-1 - 11, F0 -15 patients. F3-4 and steatosis S2-3 (p<0.05) was more common in patients of 2 gr.. Serum Ang-2 levels were higher (p<0.05) in patients of 2 gr. with F3-4, than in patients with F0-2. Fibrosis regression occurred more often in patients with 1 and 3 gr. with F1-2 than in patients 2 gr. and F3-4 and was accompanied by a decrease in Ang-2 and TGF-ß1 levels. CONCLUSION: Conclusions: High levels of Ang-2 and TGF-ß1 are registered in patients with CHC+NAFLD, which correlate with the degree of liver fibrosis and significantly decrease after successful DAAs in patients with low initial stages of liver fibrosis and normal body weight.