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"Child`s Health" (62) 2015. Тематический выпуск "Детская гастроэнтерология"

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Features of motor-secretory disorders in gasroesophageal reflux disease with concomitant obesity in young patients

Authors: Oparin A.A., Kornienko D.O. — Kharkiv Medical Academy of Postgraduate Education
PhD, Prof. Oparin A., Graduate student Kornienko D.

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Background. Gastroesophageal reflux disease (GERD) is a disease caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus. In recent years, there is a tendency to increasing of gastroesophageal reflux disease, and its significant dissemination among children and young people. Therefore,  gastroesophageal reflux disease is not only medical, but also a social problem, leading to the formation of significant complications. Although GERD is a disorder of gastrointestinal motility and structure, the motility disorder is one of the main reasons for GERD. Study of motility and secretory disorders associated with GERD, development of methods for the early diagnosis of GERD has a great scientific interest and practical importance.
At the same time, we can see the increasing of amount of patients with gastroesophageal reflux disease and comorbid pathology, including obesity. 
Overweight and obesity are particularly troubling because the extra pounds often start children on the path to health problems that were once confined to adults and  has both immediate and long-term effects on health and well-being. Therefore, the overweight is becoming more common among young people, which greatly contributes to the formation of harmful eating habits and reduced physical activity in childhood.
Obesity can also lead to poor self-esteem and depression as well as play a role in the formation of motor-secretory disorders occurring in gastroesophageal reflux disease.
Materials and methods. The study included 50 patients with gastroesophageal reflux disease. The diagnosis of gastroesophageal reflux disease is established according to ICD-10 based on a detailed survey, evaluation of complaints, history of the disease and the patient's life. For diagnosis was performed following condition: the presence of heartburn that bother the patient, one or more times a week for the past 6, as well as the data endoscopy, radiological and pH-metric methods.
After that 2 groups of patients were formed, depending on the presence of concomitant obesity. The body mass index (BMI) was applied as a measure of relative size based on the mass and height of an individual to indicate the  presence of concomitant obesity.  The BMI for a person was defined as their body mass divided by the square of their heigh. 
The first group included patients with gastroesophageal reflux disease without comorbidity, the second group included gastroesophageal reflux disease patients with concomitant obesity. The group of the control consisted of 20 healthy individuals.
Patients with symptoms suspected of gastroesophageal reflux disease were administered the GerdQ and underwent endoscopy, also they underwent pH-metery and ultrasonic scanning. The degree of the clinical symptoms we determined by the GERDQ questionnaires (self-assessment gastroesophageal reflux disease questionnaire). 
The motility and evacuational changes were determined by ultrasound investigation (model ULTIMA pro-30, made in Ukraine). The study consisted of measuring the thickness of the wall of the esophagus, hiatal diameter, width, height in the lower third of the esophagus, as well as the presence or absence of reflux (the reverse reflux of fluid from the stomach into the esophagus).
Results. The patients with concomitant obesity had severe motor disturbances that were evaluated using ultrasound (the diameter of the hiatus, the thickness of the wall of the esophagus, esophageal width in the lower third, and the presence or absence of reflux) and the intensity of the clinical manifestations of gastroesophageal reflux disease, which was determined by GERDQ (international questionnaires to diagnose gastroesophageal reflux disease) compared with the group of patients with gastroesophageal reflux disease without comorbidity.
During the ultrasound examination we determined the esophageal opening diameter, the thickness of esophageal wall, the esophagus width in the lower one third of the esophagus differed significantly in 2 groups of patients (p<0.05). The patients with gastroesophageal reflux disease of both groups had significantly higher level of motor-evacuation comparing with healthy people of the group of the control (p<0.05). 
Conclusion. 
The intragastric pH-metry parameters of gastric acidity in the stomach significantly higher in GERD patients with concomitant obesity than in GERD patients without comorbidity (p <0,05), the indicators of  gastric acidity in both categories of GERD patients was significantly higher than in group of  the control (p <0,05).
GERD patients have pronounced motor-evacuation disorders and significantly greater manifestations of the clinical symptoms which were more pronounced in gastroesophageal reflux disease patients with concomitant obesity.  It was shown by ultrasound methods, that  patients with gastroesophageal reflux disease had the increasing of the diameter of hiatal, the expansion of the lower third of the esophagus and the presence of gastroesophageal reflux (p <0,05), especially pronounced in GERD patients with concomitant obesity.

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