Vzťah medzi hladinou ghrelínu, prostaglandínov E2 a F2a a dennými údajmi o monitorovaní pH u pacientov s kombinovaným priebehom gastroezofágového refluxu a nediferencovaným ochorením spojivového tkaniva
Introduction: Gastroesophageal reflux disease (GERD) is one of the most common diseases associated with Undifferentiated Connective Tissue Disease (UCTD). GERD is a multifactorial disease, and impaired motor function of the upper gastrointestinal tract partially due to the pathology of the lower esophageal sphincter (LES), reduction in its contractive activity and decrease in esophageal clearance, delayed gastric emptying are leading in its development. Peptide hormone ghrelin takes an active part in the processes of motility and secretion modulation of the gastrointestinal tract (GIT). Some studies confirmed the role of ghrelin as a marker of gastric mucosa and upper GIT changes, but there is currently insufficient information on the role of ghrelin in case of such comorbid pathology.
Objectives: To study the extent of changes in ghrelin level in blood serum in the patients with GERD associated with UCTD and GERD as an independent disease, and their relations to pathological esophagogastroduodenal refluxes and prostaglandins E2 (PG E2) and F2a (PG F2a) in blood serum.
Materials and methods: 120 patients with GERD were examined. GERD developed on the background of UCTD syndrome in 75 patients (Group II), and GERD was not accompanied by the signs of connective tissue disease in 45 patients. The control group consisted of 20 apparently healthy individuals with no signs of UCTD. Active total ghrelin was determined in blood plasma samples, PGE2 and PGF2a indices were determined in the blood serum by enzyme immunoassay method in all patients.
Results: Ghrelin concentration in the patients with combined pathology was 5.1 times higher than in healthy individuals and 7.0 times higher compared to the patients with GERD without damage to the connective tissue. The number of refluxes with pH < 4 constituted 57 ± 8 episodes in the patients of Group I and 79 ± 6 episodes in the patients of Group II, respectively. The duration of pathological acid exposure time (AET) constituted 4.6 % of the total monitoring period in the patients of Group I and 5.48 % in Group II, and 2.45 ± 0.92 % in healthy individuals (p = 0.05). The mean De Meester constituted 23.01 ± 2.24 in Group I and 31.08 ± 2.4 – Group II (p < 0.05). The results of the correlation analysis showed correlation between the total ghrelin indices and AET in the patients with GERD associated with UCTD (r = 0.40; p < 0.05). An average direct correlation was also noted in this group of patients when comparing De Meester index and the total ghrelin indices (r = 0.43; p < 0.05). Moreover, PG E2 level in the patients’ blood was increased by 1.3 times in Group I and by 2.5 in Group II. In addition, a decrease in PG F2a by 35.30 % in the patients with GERD and by 23.3 % in case of its combination with UCTD was observed. Increase in total ghrelin circulating in the body positively correlated with PG E2 growth in blood serum and had a negative dependence on the level of PG F2a (r1=0.56; r2= –0.43; p1,2<0.05).
Conclusions: Thus, according to the conducted research, GERD development associated with UCTD was manifested by imbalance of ghrelin and prostaglandins capable of affecting gastric motility, esophageal muscle tone, enhancing or reducing the tolerance of its mucous membrane to damaging factors and affecting connective tissue metabolism, therefore they can be considered as diagnostic markers of the combined pathology.
Key words: gastroesophageal reflux disease, undifferentiated connective tissue disease, ghrelin, prostaglandin E2, prostaglandin F2a.
Lek Obz, 2020, 69 (7 – 8): 246-251
Iryna Bohdanivna ROMASH 1, Vasyl Hryhorovych MISCHUK 2, Ivan Romanovych ROMASH 3
1 Department Propaedeutics of Internal Medicine, Ivano-Frankivsk National Medical University, Ukraine
2 Department of General Practice (Family Medicine), Physical Rehabilitation and Sport Medicine, Ivano-Frankivsk National Medical University, Ukraine
3 Department of Psychiatry, Narcology and Medical Psychology, Ivano-Frankivsk National Medical University, Ukraine