Gerd: clinical solutions of problems in general practice.

INTRODUCTION: A systematic review of the results of 15 epidemiological studies showed that the prevalence of GERD in the population of Western Europe and North America is 10-20%. The frequency of GERD prevalence in the population is obviously higher than that according to the data of statistics, due to the fact that only a small amount of patients with heartburn apply for medical care, and the fact that not all doctors, especially general practitioners, devote sufficient attention to this problem. However, one of the features of modern clinical medicine is that diseases lose their mono- morbid character and more often becomes comorbid.

THE AIM: To explore the features of acid production and level of acid influence in the stomach and esophagus in patients with isolated GERD, hypertension and their comorbidity.

MATERIALS AND METHODS: For this study 4 groups were selected: group of patients with GERD, a group of patients with hypertension, the group of patients with comorbid hypertension and GERD and group without GERD and hypertension (total 78 patients). To all the patients 3-channel gastro esophageal pH monitoring was performed. In our case, we conducted a 3-hour version of the survey with standardized provoking breakfast. All patients underwent assessment of gastric secretion by original integrative indicators that reflect basal pH, number of different types of refluxes, duration of alkalization in stomach after meal.

RESULTS: GERD patients with hypertension and without are demonstrating an equal number of acid and all (nonacid + acid) reflux which is 18.9 against 19,8 (p > 0.05). But the difference between the two groups was that in patients with concomitant hypertension longer refluxes 309.3 to 179,1 (p < 0.05) were observed and the total acid exposure tends to be prolonged - 25.9 to 20.9 (p > 0.05). Our analysis of the state of gastric secretion on the results of 200-minute intra gastric pH monitoring, showed as expected more intensive acid in both groups of patients with GERD. The most "acidic" patients were GERD patients with hypertension, but compared with similar patients without hypertension, the difference was false due to the relatively small size of the samples.

CONCLUSION: Comorbidity of GERD and hypertension is characterized by severe pathological dysmotility in the lower third of the esophagus, unlike isolated GERD, which affects the increase in acid exposure and susceptibility to long reflux. A factor that may add to burden of GERD in combination with hypertension may be gastric hyperacidity and a clear predisposition to obesity.