Клинико-эндоскопическая характеристика поражения слизистой оболочки гастродуоденальной зоны у пациентов с различной массой тела и хроническим гепатитом С.

Abstract

The high prevalence and incidence of the chronic hepatitis C infection (CHC) is associated with the considerable medical and social problems, development of variety of clinical signs, hepatic and extrahepatic lesions. Due to the wide spread of this infection, there is a high comorbidity with other diseases of the gastrointestinal tract, especially of its upper parts. The objective of the study was to evaluate the clinical and pathological features of mucosal lesions (ML) of the gastroduodenal zone (GDZ) and the prevalence of Helicobacter pylori infection in patients with chronic hepatitis C with different body mass status. The study included 150 patients with chronic hepatitis C. All patients underwent fibroesophagogastroduodenoscopy (FEGD), determination of Helicobacter pylori infection (H. pylori) was done by the quick urease test (CLO-test), as well as by the stool test (CITO TEST, Farmasko LLC), the intra-esophageal pH-metric test and assessment of body mass status. The Los Angeles (LA) classification (1998) was used for endoscopic assessment of the degree of esophageal damage. Depending on the body weight of the patients, two groups were formed: A group - n=35 patients with CHC with overweight (OBW) and B group, n=115 patients with CHC with normal body weight (NBW). We found that in patients with chronic hepatitis C, gastroesophageal reflux disease (GERD) is significantly more frequently registered in patients with overweight status than in those with NBW (48.6% vs. 31.3%, p<0.05). Endoscopically, in patients with chronic hepatitis C and OBW, reflux esophagitis with the LA-B degree of mucosal damage is most common (72.7%), while in patients.with chronic hepatitis C and NBW the LA-A degree is most frequent (69.4%). Therefore, in patients with CHC + OBW, there are deeper ML than in patients with NBW. Our data demonstrates a high frequency of motor impairments in patients with chronic hepatitis C in the absence of erosive and ulcerative lesions of the mucosa of the GDZ, namely duodenogastric reflux with a predominance in persons with CHC + OBW against patients with CHC + NBW (47.0% vs. 13.9%, p<0.05). In patients with CHC, occurrence of the H. pylori infection is 34.7%, with no significant difference between patients with OBW and NBW. The high frequency of registered GERD and H. pylori in patients with chronic hepatitis C, indicates to the importance of the development of an optimal eradication treatment regimen that would be most effective, but at the same time, sufficiently safe and even gentle to the affected liver, taking into account the hepatotoxic effect of some proton pump inhibitors (PPIs), especially those that inhibit the activity of cytochrome P450, as well as the hepatotoxicity of some antibiotics.