Problems of nociception in gastroesophageal reflux disease: diagnostics and treatment of irritated oesophagus

Abstract

The following factors of gastroesophageal reflux disease (GERD) pathogenesis are addressed in the abstract: activation of nociceptors, hyperexpression of pro-inflammatory cytokines and increase of functional activity of immune competent cells. The current classification of GERD is given which is based on identification of 4 phenotypes of the disease according to diagnostic criteria and prognosis of treatment effectiveness. Importance of pH-impedance monitoring in GERD diagnostics is demonstrated based on its primary significance for identification of reflux nature and determination of relationship between GERD symptoms and reflux. The diagnostics criteria of functional heartburn and hypersensitive oesophagus according to Rome IV criteria (2016) are presented. The data of the private investigation are demonstrated according to which irritated oesophagus was observed in 26.2% of healthy persons and in 24.2% of GERD patients with endoscopic or pH-metric symptoms of the disease. Implication of oesophagus clearance disorder in GERD pathogenesis has been pointed out. An overview of the current literature data about effectiveness of surgical treatment in patients with different GERD phenotypes and also assessment of clinical effectiveness of long-term treatment with PPI are given. Advantages of anti-secretory drug of the last generation rabeprazole in different patient groups and possibilities of its use in all GERD phenotypes have been discussed.