GASTROESOPHAGEAL REFLUX DISEASE AND HELICOBACTER BACTERIAL INFECTION IN PATIENTS WITH CHRONIC HEPATITIS C WITH DIFFERENT TROPHOLOGICAL STATUS

Abstract

The widespread distribution of CHC often leads to its combined course with other diseases of the gastrointestinal tract, especially of the upper parts. Aim of the study. To study the frequency of gastroesophageal reflux disease and the prevalence of Helicobacter bacterial infection in patients with CHC with different trophological status. Object and methods. 150 patients with CHC were examined. The diagnosis of CHC was made according to the International Classification of Diseases of the 10th revision and confirmed by detection of IgG class total antibodies to HCV by enzyme immunoassay (ELISA), as well as detection in the blood of RNA-HCV patients by polymerase chain reaction (PCR). The assessment of trophological status was performed according to generally accepted anthropometric indicators – the Ketle index or the body mass index (BMI). Depending on the body weight, all patients were divided into two groups: group 1 – n = 35 patients with high body weight (HBW) and 2 group, n = 115 patients with normal body weight (NBW). The diagnosis of GERD was established according to the criteria of a unified clinical protocol (order of the Ministry of Health of Ukraine of October 31, 2013 No. 943) taking into account complaints and data of endoscopic examination. For endoscopic assessment of the degree of esophageal lesions was used the Los Angeles (LA) classification (1998). Helicobacter pylori infection (Hp) was diagnosed using a rapid urease test (CLO-test) and a coprological test (CITO TEST, manufactured by Pharmasco LLC, USA). Results of research. Complaints specific to GERD were detected in 35.3% (53 of 150) of patients with CHC. The main were: heartburn in 73.7% of patients, eructation of acid in 54.3% of patients, and dysphagia in 20.8%. A small part of patients – 11.3%, had non-esophageal manifestations characterized by a sore throat, hoarseness and dry, barking cough. Also, 85.3% (128 of 150) of patients had other complaints (hepatobiliary): pain, difficulty in the right hypochondrium, flatulence, weakness and rapid fatigue, which were more prevalent in people with CHC + HBW. It was found that 35.3% of patients with CHC have GERD, and significantly more often in people with HBW than with NBW (48.6% vs. 31.3%, p <0.05). An endoscopic picture of mucosal lesions in 56.6% of patients corresponds to LA-A. However, a comparative analysis of EGDS data in patients with different body weight revealed that patients with CHC + HBW had a greater degree of lesion of mucous LA-B (72.7%), and patients with CHC + NBW – LA-A (69.4%). That is, in patients with PMT, the mucosal lesions are deeper than in patients with NBW. There was also a high frequency of motility disorders in patients with CHC in the absence of changes in erosiveulcerative lesions of the mucous membrane, exactly duodeno-gastric reflux, which was registered in 13.4% of patients with predominance in patients with HBW, compared with patients with NBW (47.0% reverse 13.9%, p <0.05). The incidence of Hp in patients with CHC is 34.7% (52 of 150), with no significant difference between patients with HBW and NBW. Conclusion. In patients with CHC revealed a high incidence of GERD and Hp infection, which necessitates the development of an eradication regimen that would be most effective, but at the same time safe enough, and even gentle towards the affected liver.

Keywords

• chronic hepatitis c
• gastroesophageal reflux disease
• helicobacter pylori
• trophological status