medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-218medsovet-7849Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESСовременные аспекты ведения пациентов с неэрозивной рефлюксной болезньюModern aspects of managing patients with non-erosive reflux diseasehttps://orcid.org/0000-0002-9980-2294ЦукановВ. В.TsukanovV. V.

Цуканов Владислав Владимирович – доктор медицинских наук, профессор, заведующий клиническим отделением патологии пищеварительной системы у взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Vladislav V. Tsukanov - Dr. Sci. (Med.), Professor, Head of the Clinical Department of the Digestive System Pathology of Adults and Children, Scientific Research Institute  of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

gastro@impn.ruhttps://orcid.org/0000-0002-6481-3196ВасютинА. В.VasyutinA. V.

Васютин Александр Викторович - кандидат медицинских наук, старший  научный  сотрудник  клинического  отделения  патологии  пищеварительной   системы у взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Alexander V. Vasyutin - Cand. Sci. (Med.), Senior Researcher  of the Clinical Department of the Digestive System Pathology of Adults and Children, Scientific Research Institute  of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

alexander@kraslan.ruhttps://orcid.org/0000-0001-7518-1895ТонкихЮ. Л.TonkikhJu. L.

Тонких Юлия Леонгардовна – кандидат медицинских наук, ведущий научный сотрудник клинического отделения патологии пищеварительной  системы взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Julia L. Tonkikh - Cand. Sci. (Med.), Leading Researcher  of the  Clinical Department of the  Digestive System Pathology  of Adults and Children, Scientific Research Institute  of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

tjulia@bk.ruНаучно-исследовательский институт медицинских проблем СевераРоссияScientific Research Institute of Medical Problems of the NorthRussian Federation2023021120230182833Copyright © Цуканов В.В., Васютин А.В., Тонких Ю.Л., 20232023Цуканов В.В., Васютин А.В., Тонких Ю.Л.Tsukanov V.V., Vasyutin A.V., Tonkikh J.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7849

Выполнен обзор  современных  данных по ведению  пациентов  с неэрозивной рефлюксной  болезнью  (НЭРБ). Диагностика гастроэзофагеальной рефлюксной болезни  (ГЭРБ) основывается  на анализе  симптомов, эндоскопической  оценке слизистой оболочки пищевода, объективном доказательстве  рефлюкса желудочного содержимого в пищевод во время pH-импедансометрии и ответе на терапевтическое  вмешательство. Лечение ГЭРБ должно включать снижение веса при избыточной массе тела, модификацию образа  жизни и питания. Современные  консенсусы рекомендуют начинать лечение  НЭРБ с назначения ингибиторов протонной помпы (ИПП) 1 раз в день, однако отвечают на подобную терапию только 50% пациентов с этой патологией. Неполный ответ на ИПП является основанием  для увеличения  дозы ИПП и добавления  к лечению Гевискона  для нейтрализации постпрандиального «кислотного кармана». Особенно эффективен Гевискон у пациентов с постпрандиальными или ночными симптомами и у лиц с грыжей пищеводного  отверстия диафрагмы. В основе  механизма  действия Гевискона лежит образование альгинатного «плота» на поверхности желудочного содержимого, который нейтрализует кислоту и блокирует ее патологическое действие на слизистую пищевода. Современный метаанализ по лечению НЭРБ, включивший 23 работы и 10 735 больных, показал сопоставимую с ИПП эффективность монотерапии  Гевисконом при лечении в течение 4 нед. Комбинация ИПП с Гевисконом дает возможность оптимизировать ответ на лечение у пациентов с НЭРБ с неполным ответом на монотерапию ИПП. Российская гастроэнтерологическая  ассоциация полагает, что альгинаты могут применяться как в качестве монотерапии легких клинических вариантов НЭРБ, так и в схемах комплексного лечения различных вариантов ГЭРБ.

A review of current  data  on the management of patients with non-erosive reflux disease  (NERD) was made. Diagnosis of gastroesophageal reflux disease  (GERD) is based  on symptom analysis, endoscopic  evaluation of the esophageal mucosa, objective  evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason  to increase  the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism  of action of Gaviscon is based  on the formation  of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included  23 studies  and 10,735  patients, showed  the  efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens  for various GERD variants.

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The authors declare that there are no conflicts of interest present.