Особливості клінічного перебігу дуоденогастрального рефлюксу у хворих на хронічний гастрит

Abstract

Метою роботи було провести оцінку особливостей клінічного перебігу дуоденогастрального рефлюксу (ДГР) у хворих на хронічний гастрит (ХГ) та встановити частоти і взаємозв’язок клінічних проявів в залежності від різних патологічних змін слизової оболонки шлунка. Дане дослідження основане на ретроспективному аналізі результатів обстеження 45 хворих з ДГР та ХГ у віці від 18 до 50 років. Встановлено, що при ДГР наявність інфікованості H. pylori (Hp) має прямий зв’язок з вірогідністю розвитку гастродуоденальних ерозій (ГДЕ), а присутність Hp-інфекції чи ГДЕ – з вірогідністю розвитку диспепсичного, абдомінального та астено-вегетативного синдромів (відношення шансів (ВШ) перевищує 1). Оскільки обидва значення меж вірогідного інтервалу ВШ вище 1 (при рівні значимості p<0,05), робиться висновок про статистичну значимість виявленого зв’язку. При p<0,05 (по точному критерію Фішера) нульова статистична гіпотеза відхиляється, а приймається альтернативна гіпотеза про залежність ознак.

The issues regarding duodenogastric reflux (DGR) in patients with chronic gastritis (CG) are currently relevant, primarily, due to its widespread prevalence (25-40% of the total population); it is significantly affects the quality of life of these patients and in 2-5% of cases is a reason to consult a family physician. In most cases, DGR is diagnosed against the background of many functional and organic diseases of the digestive organs (in 45-100% of cases), primarily, gastroduodenal zone, affecting the clinical symptoms of reflux and significantly masking it. The aim of the study is to evaluate DGR clinical features in patients with CG and determine the frequency and relationship of clinical manifestations depending on various pathological changes in the gastric mucosa. The object and methods. The study is based on a retrospective analysis of the examination data of 45 patients with DGR and CG aged from 18 to 50 years (32.4 ± 11.9 years). All patients were examined according to the diagnostic algorithm for unexplored dyspepsia. Statistical processing of data was carried out according to the algorithm for statistical data analysis, description and presentation of qualitative variables using MedCalc Software bvba software package, Ostend, Belgium, 1993-2019. The study includes analysis of manifestation frequency in patients with binary or dichotomous variables with 95% confidence interval. The contingency tables or crosstabs were used for all possible pairs (tables “2x2”) of the following features: presence of H. pylori (Hp), gastroduodenal erosions (GDE), development of dyspeptic syndrome (DS), abdominal syndrome (AS) and astheno-vegetative syndrome (AvS). The four-column tables were used to calculate the odds ratio (OR) with 95% CI, which made it possible to determine not only the statistical significance of the relationship between the factor and the effect, but also its quantitative assessment. To analyze the frequency differences and assess their significance in two independent research groups, we used a non- parametric criterion − two-sided Fisher’s exact test (FET). Determination of FET allowed us to study the relationship between the certain factors and consequences, compare the frequency of pathological conditions between two research groups. The critical level of significance in all cases was α = 0.05. The study presented formulation of the null and alternative statistical hypotheses. Based on the data obtained, it was determined that in case of DGR in patients with CG the main clinical manifestations were characterized by the symptoms of DS, AS and AvS. In bile reflux syndrome, the presence of Hp is directly related to the probability of GDE development and the presence of Hp or GDE – with probability of DS, AS and AvS development (OR exceeds1). Since both values of the limits CI OR are higher than 1 (at a significance level p <0.05), the revealed relationship was concluded to be statistically significant. The chances of GDE development in the presence of Hp in case of DGR in patients with CG are 8.96 times higher than in Hp absence (95% CI: 2.01 – 39.92), p = 0.004. The chances of DS, AS and AvS development in case of DGR in patients with CG in the presence of Hp are 14.5; 10.91 and 19.07 times higher respectively, than in its absence and are statistically significant. The chances of DS, AS and AvS development in case of DGR in the presence of GDE are 16.0, 17.94 and 13.62 times higher respectively, than in their absence and are statistically significant. When p <0.05 (according to FET), the null statistical hypothesis Ho is rejected and alternative hypothesis Ha regarding the features dependence is accepted, namely, the presence of Hp in patients with CG with concomitant DGR increases the risk of GDE, and the presence of Hp or GDE increases the risk of DS, AS and AVS development.