GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH FUNCTIONAL DYSPEPSIA AND CONSTIPATION PREDOMINANT IRRITABLE BOWEL SYNDROME: CLINICAL FEATURES AND EFFICACY OF LACTULOSE AND ITOPRIDE HYDROCHLORIDE ; ГАСТРОЭЗОФАГЕАЛЬНАЯ РЕФЛЮКСНАЯ БОЛЕЗНЬ У ПАЦИЕНТОВ С ФУНКЦИОНАЛЬНОЙ ДИСПЕПСИЕЙ И СИНДРОМОМ РАЗДРАЖЕННОГО КИШЕЧНИКА С ЗАПОРОМ: КЛИНИЧЕСКИЕ ОСОБЕННОСТИ И ОЦЕНКА ЭФФЕКТИВНОСТИ ТЕРАПИИ ЛАКТУЛОЗОЙ И ИТОПРИДА ГИДРОХЛОРИДОМ

Background: The frequent coexistence of gastroesophageal reflux disease (GERD) with functional dyspepsia (FD) and an irritable bowel syndrome (IBS) has been described in the literature. Aim: To study the specific features of GERD clinical course and diagnosis in patients with GERD in combination with FD and constipation predominant IBS (IBS-C) in comparison to patients with isolated GERD; to assess the efficacy of lactulose and itopride hydrochloride. Materials and methods: A total of 60 patients with GERD, FD (Rome criteria III), and IBS-C (Rome criteria III) and 29 patients with isolated GERD were examined. GERD diagnosis was based on clinical, endoscopic, and pH-metric criteria. For 4 weeks 10 patients with combination of non-erosive reflux disease (NERD), FD and IBS-C received lactulose monotherapy and other 10 patients received combination of lactulose with itopride hydrochloride. Clinical symptoms and pH-metric parameters were assessed before and 4 weeks after treatment. Results: Combination of GERD, FD and IBS-C was noted more frequently in women under 40 with normal body mass index (р0.05). Classic GERD symptoms were absent in 43.4% of patients with gastrointestinal comorbidity and in 10.3% of patients with isolated GERD (р=0.004). A higher prevalence of belching and nausea was found in patients, suffering from GERD, FD and IBS-C, than in those with isolated GERD (р0.05). After 4-week lactulose and itopride hydrochloride treatment all the patients with GERD, FD and IBS-C showed a reduction of clinical symptoms (p0.05) and normalization of pH-metric parameters (р0.001). Conclusion: GERD course in patients with concomitant FD and IBS-C has the following peculiarities: predominance of women, absence of classic GERD-symptoms in almost half of these patients, and frequent combination with other functional symptoms. Combination therapy with lactulose and itopride hydrochloride enables successful control of GERD and FD symptoms as well as esophageal pH normalization. ; Актуальность. В ряде исследований описано ...