UA91297U - Method for differential diagnostics of gastro-esophageal reflux disease - Google Patents

Abstract

A method for differential diagnostics of gastroesophageal reflux disease includes examination of patient and saliva sampling. Besides that, by spectrophotometric method at wavelength of 540 nm optical density of patient’s saliva sampled at empty stomach in 30 minutes after tooth brushing and careful rinsing oral cavity with distillated water is determined, with measurement of concentration of calcium, and if calcium concentration in patient’s saliva is lower than 0.73 mmol/l a non-erosive form of gastroesophageal reflux disease is diagnosed, and if concentration is lower than 0.36 mmol/l an erosive form of gastroesophageal reflux disease is diagnosed.

Description

A useful model belongs to medicine, namely to gastroenterology and therapy, and can be used to diagnose non-erosive or erosive forms of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is an important and urgent problem of modern gastroenterology due to the following reasons: GERD is one of the most common diseases of the digestive organs (up to 4095 of the population suffers from this pathology); there is a trend towards an increase in the incidence and prevalence of GERD 111.

GERD significantly worsens the quality of life of patients, which, in turn, causes a decrease in work capacity, an increase in the level of anxiety, the development of concomitant diseases, a decrease in work productivity, an increase in the number of days of temporary incapacity for work, which leads to economic losses.

The widespread prevalence of GERD causes significant financial costs for the diagnosis and treatment of this disease. According to the algorithm recommended by the American Gastroenterological Association, performing an endoscopy of the upper parts of the digestive tract is the first mandatory step, however, the presence of erosive defects of the mucous membrane of the distal part of the esophagus occurs only in 40 95 patients with GERD, and in the rest of the patients the disease is not confirmed endoscopically I2I . In the absence of lesions of the esophagus endoscopically or radiographically, an endoscopically negative variant of the disease is confirmed, which requires verification of the diagnosis (by functional tests. The "gold standard" of diagnosis was considered daily intraesophageal pH-monitoring of IZ). However, the high cost of the method, its invasiveness, and the inconvenience of performing the test, which cannot be completely eliminated even with the use of the "Vgamo" radiocapsule, justify the feasibility of creating and introducing into clinical practice a non-invasive, accessible diagnostic technique

GERH.

A known method of differential diagnosis of pathological gastroesophageal reflux and gastroesophageal reflux disease, which consists in studying anamnestic data, conducting a clinical examination, fibroesophagogastroduodenoscopy, histological examination of biopsies of the esophageal mucosa, and intraesophageal pH-monitoring, additionally determine the intervals of the total bap of clinical signs of pathological

From gastroesophageal reflux according to the interviewer questionnaire and the intervals of Kk coefficient values of GH autoantibody titers when finding the K coefficient value in the range from 0 to 2.3 and the total questionnaire score in the range of 30-60 in combination with at least one presented criterion of esophageal damage, pathological gastroesophageal reflux is diagnosed reflux; when finding the value of the coefficient K in the range of 2.3-5.3 and more and the total questionnaire score in the range of 40-60 in combination with at least one of any of the presented criteria for damage to the esophagus, gastroesophageal reflux disease I4Y is diagnosed. However, this method is difficult to perform, invasive, requires expensive medical equipment, and is not suitable for widespread use.

There is a known method of diagnosing a form of gastroesophageal reflux disease combined with angina pectoris, which consists in the fact that patients undergo an ultrasound examination to determine the thickness of the esophageal wall, the diameter of the esophageal opening of the diaphragm, the width of the esophageal lumen in the lower third, as well as the presence or absence of reflux, and with the width of the lower third of the esophagus 2.54х0.06 cm, the diameter of the esophageal opening of the diaphragm 1.87:50.05 cm, the duration of reflux 5.401 min. diagnose a non-erosive form of gastroesophageal reflux disease, with the width of the lower third of the esophagus 2.9830.07 cm, the diameter of the esophageal opening of the diaphragm 2.250.06 cm, the duration of reflux 7.450.09 min. diagnose an erosive form of gastroesophageal reflux disease 51. However, this method is used for patients with angina pectoris, requires complex hardware, specially trained medical personnel, the allocation of a separate room and the calculation of many indicators.

The prototype selected a method of diagnosing gastroesophageal reflux disease, which includes examination of patients and taking a sample of saliva with a volume of 4 ml by the potentiometric titration method of determining the value of the buffer capacity of the patient's saliva solution, calculating the ratio of the integral of the dependence of the buffer capacity of the saliva solution on his

RA in the interval 7-10 to the integral of the dependence of the buffer capacity on pH in the interval 4-7 and in the case when the ratio of the integrals corresponds to the value of ov in the interval 0.92-1.28, tastroesophageal reflux disease is diagnosed without reflux esophagitis, and when 1 .35-1.05 - gastroesophageal reflux disease with VI reflux esophagitis.

The prototype method is non-invasive and does not require expensive hardware. because However, the closest analogue requires complex mathematical calculations and, accordingly,

trained personnel. All of the above indicates the need to create a non-invasive differential diagnosis of GERD, available for wide use.

The basis of a useful model is the task of creating an effective non-invasive differential diagnosis of gastroesophageal reflux disease.

The task is solved by the fact that in the method of diagnosing gastroesophageal reflux disease, which includes examining the patient and taking a saliva sample, according to a useful model, the optical density of the patient's saliva sample taken on an empty stomach 30 minutes after brushing teeth is determined by the spectrophotometric method at a wavelength of 540 nm and thorough rinsing of the mouth with distilled water, the concentration of calcium is measured in it, and if the concentration of calcium in the patient's saliva is below 0.73 mmol/l, a non-erosive form of gastroesophageal reflux disease is diagnosed, and if the concentration is below 0.36 mmol/l, the erosive form of gastroesophageal reflux disease is diagnosed .

The proposed method is a simple, non-invasive, affordable method of differential diagnosis of gastroesophageal reflux disease. The technical result, which is obtained as a result of solving the task, consists in the ability to prescribe timely and adequate therapy and increase the effectiveness of the treatment of patients with

GERH.

The method of differential diagnosis of gastroesophageal reflux disease is performed as follows. Before carrying out diagnostic measures, the absence of clinical symptoms of malabsorption, biochemical signs of kidney or liver failure is clarified. To determine the concentration of calcium in the patient's back, a sample of his saliva is prepared. Saliva collection is performed before meals, 30 minutes after brushing teeth and thoroughly rinsing the mouth with distilled water. The patient spits into a sterile glass, from which a saliva sample of 0.2 ml is taken. The concentration of calcium in saliva is determined using the calcium-sensitive dye arsenazo-NII by the spectrophotometric method according to the formula:

Calcium concentration (mmol/l) t (Ed x 2.5 mmol", where Ed is the optical density of the patient's saliva sample, nm;

Ek - optical density of the control sample, nm; 2.5 mmol/l - calcium concentration in the control sample.

If the concentration of calcium in the patient's saliva is below 0.73 mmol/l, a non-erosive form of gastroesophageal reflux disease is diagnosed, and when the concentration is below 0.36 mmol/l, an erosive form of gastroesophageal reflux disease is diagnosed.

To determine the accuracy of the declared method of diagnosing bupo, 85 patients were examined on the basis of the Department of Me 1 therapy and medical diagnostics of the Danylo Halytsky Lviv National Medical University. The diagnosis of all patients was established according to known methods: questionnaires using a modified Likert questionnaire, endoscopy of the upper parts of the alimentary canal, and daily RI monitoring of the esophageal mucosa. According to the examinations, all patients were diagnosed with GERD (erosive form - 255 people, neurosive form - 40). Then the patients were diagnosed according to the claimed method, according to the calcium content in the saliva. Statistical processing of the obtained material was carried out using the BROO ZiayeTsOob 17.0 software on a personal computer. Differences at a significance level of r0.05 were considered probable.

To determine the most significant criteria, the obtained material was processed using mathematical methods. With the help of KOS analysis (Keseimeg Oregaypo Spagasivtivno

Following) the cut-off point of the "sick-healthy" and "present-absent esophagitis" groups is selected for the best values of sensitivity and specificity of the test. Yes, for the group with a non-erosive form

The GERD "cut-off point" is set at a calcium concentration in saliva of 0.73 mmol/l. With this value, the sensitivity of the test is 81.8 965, and the specificity is 80.4 95. For the group with the erosive form of GERD, the "distribution point" is set at the level of calcium concentration in saliva of 0.39 mmol/l. At such a "cut-off point", the sensitivity of the test is 85.7 95, and the specificity is 81.8 96. Thus, with a high degree of reliability, a non-erosive form of GERD can be diagnosed with a concentration of calcium in saliva of less than 0.73 mmol/l, and when the concentration calcium in the back does not exceed 0.36 mmol/l - erosive form of GERD.

The fact that the calcium concentration was determined by a spectrophotometric method based on the formation of colored complexes specific for calcium is also evidence in favor of the sufficient sensitivity of the method of diagnosis according to the claimed method and the reliability of the obtained diagnostic data. Normal values of the level of calcium in human saliva, established by the authors of the claimed method on 22 practically healthy volunteers, correspond to 1.030, mmol/l. for Clinical examples of implementation of the claimed method.

Example 1. Patient V., 42 years old, consulted a gastroenterologist with complaints of pronounced daily heartburn and acid belching. He periodically noted a feeling of heaviness, swelling in the epigastrium, which decreased after belching. Deterioration of the condition was observed during the last month. On examination: the general condition is satisfactory, the tongue is moist, with a moderate white coating. The condition of the skin, heart, and lungs is normal. CH - 71 per minute, BP - 124/84 mm Hg. art., tones are clear. Abdomen is soft, not painful. The liver and spleen are not enlarged. There are no swellings. Physiological parameters are normal. The results of clinical tests of blood and urine correspond to the norm.

The patient was diagnosed according to the claimed method. On an empty stomach, 30 minutes after brushing the teeth and thoroughly rinsing the mouth with distilled water, a back sample was taken in a sterile glass, from which 0.2 ml was then taken. For the control sample, 0.2 ml of distilled water was prepared. Each sample was drunk into a separate glass cuvette and the optical density of saliva was determined on a spectrophotometer when irradiated with light with a wavelength of 540 nm. The concentration of calcium in the patient's saliva was calculated - 027 mmol/l. Since the calcium content in the patient's saliva is lower than 0.36 mmol/l (diagnostic value), the erosive form of GERD is diagnosed.

In order to verify the correctness of the established diagnosis, patient V. underwent additional studies. FEGDS: erosive esophagitis of the B stage, superficial gastropathy. Daily pH-metry of the distal part of the esophagus: the duration of time 3 OH less than 4.0 was 37.3 95. Diagnostic conclusion by instrumental methods - GERD, erosive Form. Thus, the diagnosis by the claimed method was confirmed.

Example 2. Patient b., 27 years old, consulted a gastroenterologist with complaints of moderate daily heartburn and acid belching. She periodically noted a feeling of heaviness, swelling in the epigastrium. Deterioration of the condition was observed during the last three months. During the examination: the general condition is satisfactory, the tongue is wet, with a slight bubbling plaque. The condition of the skin, heart, and lungs is normal. Heart rate - 88 per minute, BP-114/74 mm Hg. art., tones are clear. Abdomen is soft, not painful. The liver and spleen are not enlarged. There are no swellings. Physiological parameters are normal. The results of clinical tests of blood and urine correspond to the norm.

The patient was diagnosed according to the claimed method. Fasting, 30 minutes after

After brushing the teeth and thoroughly rinsing the mouth with distilled water, a back sample was collected in a sterile glass, from which 0.2 ml was then taken. For the control sample, 0.2 ml of distilled water was prepared. Each sample was poured into a separate glass cuvette and the optical density of saliva was determined on a spectrophotometer when irradiated with light with a wavelength of 540 nm.

The concentration of calcium in the patient's saliva was calculated - 0.57 mmol/l. Since the calcium content in the patient's back is lower than 0.73 mmol/l (diagnostic value), a non-erosive form of GERD was diagnosed.

To check the correctness of the established diagnosis, the patient b. conducted additional research. FEGLDS: superficial ogastropathy. Daily pH-metry of the distal part of the esophagus: the duration of time with pH less than 4.0 was 15.4 95. Diagnostic conclusion by instrumental methods - GERD, non-erosive form. Thus, the diagnosis by the claimed method was confirmed.

The method of differential diagnosis of gastroesophageal reflux disease is non-invasive, easy to perform, economically available for use in wide clinical practice.

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Yu.M. Stepanov, G.Ya. Budzak, S.V. Kosynska // Modern gastroenterology. - 2012. - Mo 2 (54). - 0. t09-113. 2. Kappav R.) Atepsap Savztoepivgoiodisa! Avvosiaiop tedisa! rovniop videotepi op She tapadetepi oi davitoevorpadea! heikh diseave / R..Yu. Kaitav, MU. Bpanpeep, M.R. MUaeti //

SazigoepiotoIodu. - 2008. - Mine. 135. - R. 1383-1391.

Z. Chernobrovy V.M. Resistance to proton pump inhibitors in gastroesophageal reflux disease: ways to solve the problem (literature review) / V.M. Chernobrovyi, S.G.

Melashchenko // Modern gastroenterology. - 2011. - Mo 3 (593. - P. 78-85. 4. Patent of Ukraine for utility model Me 69330 A, МИК З01М 3349, 01 М3У53, AB В 11/27; publ. 08/15/2004, bull. Mo 8. 5. Patent of Ukraine for utility model Me 489261, IPC ABIV 28/00, published 04/25/2010, Bull.

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Claims (1)

USEFUL MODEL FORMULA The method of differential diagnosis of gastroesophageal reflux disease, which includes examination of the patient and taking a saliva sample, which differs in that the optical density of the patient's saliva sample, taken on an empty stomach 30 minutes after brushing the teeth and thoroughly rinsing the mouth with distilled water, is determined by the spectrophotometric method at a wavelength of 540 nm , the calcium concentration is measured in it, and when the concentration of calcium in the patient's saliva is below 0.73 mmol/l, a non-erosive form of gastroesophageal reflux disease is diagnosed, and when the concentration is below 0.36 mmol, the erosive form of gastroesophageal reflux disease is diagnosed.