Pathogenesis, diagnosis and treatment of reflux esophagitis in patients after gastric surgery
https://doi.org/10.21518/2079-701X-2015-13-14-19
Abstract
The article describes the experience of treatment of erosive reflux esophagitis in 30 patients after gastric resection, having mixed reflux determined by 24-hour esophageal pH-impedancemetry. Pharmacotherapy for background and maintenance treatment included a combination of PPI (Omez) with UDCA (Livodexa). The efficacy of different dosages of the drugs was evaluated in 2 groups of patients during background treatment: group 1 received Livodexa 10 mg/kg in combination with Omez 20 mg per day, group 2 received Livodexa 15 mg/kg in combination with Omez 40 mg/day. During maintenance treatment, subgroup 1 received Livodexa 2.5 mg/kg and Omez 20 mg, subgroup 2 - 5.0 mg/kg Livodxa and Omez 20 mg per day for 2 months. Changes in the clinical and endoscopic patterns were evaluated. The study showed that, according to the clinical and endoscopic data, Livodexa 15 mg/kg and Omez 40 mg/day for 112 days for erosive RE was effective in 76.6% (23) of cases. In the remaining 7 (23.4%) patients erosions healed by the 140th day of treatment. With regard to maintenance treatment, the combination of Livodexa 5.0 mg/kg with Omez 20 mg/day was effective.
About the Authors
O. N. Minushkin
Teaching and Research Medical Center Federal State Institution of the Russian Federation Presidential Administration, Moscow, Russia
Russian Federation
Russian Federation
L. V. Maslovskiy
Teaching and Research Medical Center Federal State Institution of the Russian Federation Presidential Administration, Moscow, Russia
Russian Federation
Russian Federation
A. G. Shuleshova
Teaching and Research Medical Center Federal State Institution of the Russian Federation Presidential Administration, Moscow, Russia
Russian Federation
Russian Federation
N. S. Nazarov
Teaching and Research Medical Center Federal State Institution of the Russian Federation Presidential Administration, Moscow, Russia
Russian Federation
Russian Federation
References
1. Русанов А.А. Резекция желудка, монография, 2007: 1-7.
2. Минушкин О.Н., Масловский Л.В., Шулешова А.Г, Назаров Н.С. Курсовое и поддерживающее лечение больных c рефлюкс-эзофагитом после гастрэктомии или резекции желудка. Терапевтический Архив, 2014, 86, 8: 50-55.
3. Волков В.Е., Волков С.В. Современные представления о роли нижнего эзофагеального сфинктера в патогенезе еюноэзофагеальной рефлюксной болезни. Вестник Чувашского Университета, 2013, 3: 379-387.
4. Kim EM, Jeong HY, Lee ES et al. Comparision between proximal gastrectomy and total gastrectomy in early gastric cancer. Korean J Gastroenterol, 2009 Oct., 54(4): 212-9.
5. Wen L, Chen XZ, Wu B et al. Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis. Hepatogastroenterology, 2012, Mar-Apr. 59(114): 633-40.
6. Yoo HY, Venbrux A, Heitmiller R et al. Control of alkaline reflux esophagitis after total gastrectomy by percutaneous jejunostomy tube. J Clin gastroenterol, 2002, 35. 1: 46-49.
7. Matikainen M, Laatikainen T, Kalima T et al. Bile acid composition and esophagitis after total gastrectomy. Am J Surg, 1982, 143: 196-98.
8. Batzri S, Harmon JW, Schweitzer EJ and Toles R. Bile acid accumulation in gastric mucosal cells. Proc. Soc. Exp. Biol. Med., 1991, 197: 393-399.
9. Kono K, Takahashi A, Sugai H et al. Oral trypsin inhibitor can improve reflux esophagitis after distal gastrectomy concomitant with decreased trypsin activity. Am J Surg, 2005, Sep. 190 (3): 412-7.
10. Янова О.Б., Трейман Е.В., Туник Н.В. Роль кис-лотообразования в культе резецированного желудка в патогенезе пострезекционных осложнений. XI съезд НОГР. Тезисы докл. М.: ЦНИИ гастроэнтерологии. 2011. С. 244.
11. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO. Castell DO Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology, 2001, Jun. 120(7): 1599-606.
12. De Vault KR, Georgeson S, Castell DO. Salivary stimulation mimics esophageal exposure to reflux duodenal contents. Am. J. Gastroenterol, 1993, 88: 1040-1043.
13. Singh S, Bradly LA, Richter JE. Determinacy of esophageal alkline pH enviroment and controls in-patients with GERD. Gut, 1993, 34: 309-316.
14. Bechi P, Paucciani F, Baldini F et al. Long-term ambulatory enterogastric reflux monitoring. Validation of new fiberoptic technique. Dig. Dis. Sci, 1993, 38: 1297-1306.
15. Vaezi MF. Richter JE. Role of acid and duode-nogastroesophageal reflux in gastro-oesopha-geal reflux disease. Gastroenterol, 1996, 111: 1192-1199.
16. Трухманов А.С., Кайбышева В.О. рН-импедансометрия пищевода. Пособие для врачей. Под ред. акад. РАМН, проф. В.Т. Ивашкина. М.: ИД «МЕДПРАКТИКА-М», 2013. 32 с.
17. Champion G, Richter JE, Vaezi MF et al. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett's esophagus. Gastroenterology, 1994, 107: 747.
18. Netzer P, Gut A, Brundler R et al. Influence of pantoprazole on oesophageal motility, and bile and acid reflux in patients with oesophagitis. Aliment Pharmacol Ther, 2001, 15: 1375.
19. Karamanolis G, Vanuytsel T, Sifrim D Yield of 24-hour esophageal pH and bilitec monitoring in patients with persisting symptoms on PPI therapy. Dig Dis Sci, 2008, Sep. 53(9): 2387-93.
20. Vaezi MF, Richter JE. Contribution of acid and duodenogastrooesophageal reflux to oesopha-geal mucosal injuryand symptoms in partial gastrectomy patients. Gut, 1997, 41: 297-302.
Review
For citations:
Minushkin ON, Maslovskiy LV, Shuleshova AG, Nazarov NS. Pathogenesis, diagnosis and treatment of reflux esophagitis in patients after gastric surgery. Meditsinskiy sovet = Medical Council. 2015;(13):14-19. (In Russ.) https://doi.org/10.21518/2079-701X-2015-13-14-19
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