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Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) является актуальной проблемой в современной гастроэнтерологии, что обусловлено высокой распространенностью заболевания, широким спектром предъявляемых пациентами жалоб, развитием тяжелых осложнений, а также необходимостью длительной терапии. Целью работы явился анализ эффективности медикаментозного лечения ГЭРБ у пациентов, находившихся под диспансерным наблюдением терапевта и гастроэнтеролога в поликлиническом отделении ГБУЗ РМ «Республиканская клиническая больница № 5» в период с 2017 по 2020 гг. В ходе исследования проведена ретроспективная оценка данных амбулаторных карт пациентов разных возрастных групп с гастроэзофагеальной рефлюксной болезнью. При анализе амбулаторных карт определяли характер жалоб и условия их возникновения, наличие осложнений и сопутствующих заболеваний со стороны желудочно-кишечного тракта, группы препаратов и их комбинации, применяемые для лечения, регулярность приема лекарственных средств и эффективность назначенного лечения. В результате проведенного исследования было отмечено, что для лечения ГЭРБ на амбулаторном этапе применялась комбинированная терапия, которая в 100% случаев была рациональной. Наиболее часто назначаемой схемой лечения ГЭРБ явилась комбинация ингибитора протонной помпы, прокинетика и антацида. Лечение больных в исследуемой группе было эффективным в 60% случаев. В 30% случаев больные отмечали улучшение, но не с полным исчезновением симптомов либо с их периодическим рецидивированием, и 10% исследуемых не отметили улучшения после лечения. Ключевые слова: гастроэзофагеальная рефлюксная болезнь, лечение, комбинированная терапия, эффективность, амбулаторная практика.

Introduction. The problem of gastric ulcer is of particular socio-economic importance and has a tremendous impact on the quality of life of people. The relevance of our study is due to an increase in the incidence of peptic ulcer in the population, the variability of the clinical picture depending on the age category of patients, and the peculiarities of the treatment of this gastrointestinal pathology.The aim of the study is to study the features of the course of gastric ulcer in different age groups of patients under dispensary supervision in the outpatient department of the State Budgetary Healthcare Institution of the Republic of Moldova “Republican Clinical Hospital No. 5” in the period from 2017 to 2020.Materials and methods. A retrospective analysis of outpatient records of 100 patients of different age groups with gastric ulcer who were under dispensary observation at the outpatient clinic of the Republican Clinical Hospital No. 5 in Saransk in 2017– 2020 was carried out. Statistical analysis of the data obtained was carried out using the Microsoft Office Excel program.Results and discussion. It was found that gastric ulcer is more often observed in middle-aged and elderly patients and is accompanied by blurring of the clinical picture of the disease, in contrast to young people, who have vivid clinical manifestations of this disease. Ulcerative defects in  young and middle-aged patients are more often small in  size and are located mainly in the area of the stomach angle, and in elderly and senile patients, ulcers are localized mainly in the cardiac region, can be gigantic and often lead to the development of complications (primarily gastrointestinal intestinal bleeding).Conclusions. The blurring of the clinical picture, the absence of pathognomonic symptoms in elderly patients determine the late diagnosis of gastric ulcer, which ultimately leads to a high incidence of complications requiring surgical intervention. In clinical practice, it is necessary to take into account these features of the course of peptic ulcer disease in elderly patients and to prescribe the necessary complex of laboratory and instrumental studies and preventive therapy in a timely manner.

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The aim of present work was to assess the role of immunological disorders, hypoxia and lipoperoxidation in development and progression of erosive/ulcerative lesions of duodenum accompanied by chronic cerebrovascular insufficiency. We have studied a cohort of 125 patients with erosive and ulcerative lesions of duodenum associated with chronic disorders of cerebral circulation, aged from 48 to 74 years old. They underwent outpatient treatment and care at the Clinical Hospital No.5 (Saransk) over 2015-2018. A comparison group consisted of 39 patients with chronically impaired cerebral circulation, who did not show signs of erosive/ulcerative lesions of stomach and duodenum over the study period. Patients received conventional anti-ulcer therapies for 14 days. The cytokine profile, indexes of hypoxia, and serum markers of lipid peroxidation were evaluated. The study has shown an increase in the level of pro-and anti-inflammatory cytokines in cases with erosive/ ulcerative duodenal lesions associated with chronic impairment of cerebral circulation throughout the observation period, thus indicating to evolving imbalance of immunoregulatory system. The development of hypoxic changes in the blood plasma was observed, which was confirmed by increased contents of lactic and pyruvic acids, like as the hypoxia coefficient at all the observation terms. The lipid peroxidation processes were also activated in the course of evolving disorder, as judged by increased contents of diene conjugates, triene conjugates and the malonic dialdehyde levels upon admission, as well as on day 7 and 14 of observation, associated with decrease in the antioxidant potential of blood plasma, estimated by the superoxide dismutase index. A trend for a decrease in the indexes of diene conjugates, triene conjugates, malonic dialdehyde and an increased levels of superoxide dismutase was registered as late as after 30 days of observation. Hypoxia and lipid peroxidation may be viewed as predictors of chronic inflammation. Developing imbalance between pro-inflammatory, anti-inflammatory cytokines, and chronic hypoxia are of significant value for pathogenesis of erosive-ulcerative lesions of duodenum, being associated with chronic impairment of cerebral circulation. Under such conditions, oxidative stress is observed, with a shift of equilibrium towards pro-oxidants, along with exhausted potential of antioxidant defense system. In general, these disturbances determine the pathogenetic mechanisms of damage that occur in erosive and ulcerative lesions of duodenum, being associated with chronic cerebrovascular insufficiency, which have a mutually negative influence in the course of disease progression.