Background: Gastroesophageal reflux disease (GERD) has a high prevalence worldwide and plays a major role in the development of Barrett's esophagus (BЕ) and esophageal adenocarcinoma. Aims: To evaluate the patterns of esophageal acidification and esophageal motility in patients with BЕ in comparison with various GERD phenotypes and control subjects. Materials and methods: 100 patients were examined: 31 patients with nonerosive reflux disease (NERD), 20 patients with erosive reflux disease (ERD), 17 patients with BE, 32 healthy individuals who made up the control group. All patients underwent 24-hours pH-impedance and high-resolution esophageal manometry. Results: According to the 24-hour pH-impedanсe, the total time with pH 4 in the esophagus was 1,9% in control patients, 11.6% in the NERD group, 19.35 in the ERD group and 28% in patients with BE. The average number of acid refluxes was 18.0 in the control group, 58.0 in the group with NERD, 78. in the group with ERD and 89.0 in patients with BE. The number of acidic refluxes was significantly correlated with the time on the acidification of the esophagus (r = 0.5439; p0.05). The analysis of the mean nocturnal baseline impedance (MNBI) revealed a tendency to decrease the values in patients with GERD relative to the control subjects, and there was a decrease in the values of MNBI as the severity of GERD from NERD to ERD and BE (p0.05). Manometric signs of hiatal hernia and/or hypotension of the lower esophageal sphincter were more often registered in the groups of patients with ERD (70%) and BE (65%) than in patients with NERD (32%) and in control group (12%). Conclusions: Increase in level of total time with pH 4, number of acid refluxes, reduced values of MNBI, as well as disorders of the structure and function of the esophagogastric junction and motility of the esophagus are associated with the severity of esophagus diseases.

Aim. Evaluation of the effectiveness of esophagoprotection in covering up short periods of withdrawal of maintenance therapy with proton pump inhibitors (PPIs) in patients with Barrett's esophagus (BE). Materials and methods. A retrospective analysis of the data of patients with histologically verified BE who received outpatient PPI therapy for at least 12 months was carried out. This cohort was divided into two groups to compare depending on the treatment regimen received. The first group included only patients who take PPIs constantly, while the second group included patients who had periodic interruptions in taking PPIs. In the second group, we analyzed only cases where to cover up the periods of PPI withdrawal the patients used the esophagoprotector Alfasoxx (10 ml 4 times a day, after each meal and at night). In the cohort, demographic data (age, gender), risk factors, length of the BE segment, degree of dysplasia, number of relapses of erosive esophagitis, and the data of high-resolution manometry on movement disorders of the thoracic esophagus (ineffective motility and lack of contractility) were analyzed. Results. The study included 39 patients (28 men and 11 women) with histologically verified BE. The average age was 57,1538 years (95% confidence interval 53.4269–60.8808). The gender structure was dominated by men (n=28). The duration of BE history in the analyzed cohort was 5.6769 years (95% confidence interval, 4.6161–6.7378). The first group consisted of 23 patients who take PPIs constantly. The second group consisted of 16 patients who had periodic interruptions in taking PPIs, which were covered by the esophagoprotector Alfasoxx. In the analyzed cohort, there were no significant differences between the groups in the average length of the BE segment, the number of patients with a long BE segment, the degree of dysplasia, the number of relapses of erosive esophagitis, and the rate of movement disorders of the thoracic esophagus. Conclusion. In routine practice, there are reasons for the temporary withdrawal of PPIs in patients with BE, which requires the administration of course esophagoprotection to cover up the risks. The results of this retrospective comparative study demonstrate the effectiveness of this strategy.

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Aim. To determine predictors of insufficient effectiveness of proton pump inhibitors based on the parameters of 24-hours pH-impedance and features of motor function of the esophagus in patients with Barrett's esophagus. Materials and methods. 17 patients with histologically verified Barrett's esophagus undergoing acid-suppressive therapy were examined. All patients underwent 24-hours pH-impedance and high-resolution esophageal manometry. Results. According to daily pH-impedance, group 1 consisted of 11 patients with an adequate response to antisecretory therapy, group 2 6 patients with insufficient effectiveness of antisecretory therapy, 5 of whom had no clinical manifestations. The total number of reflux averaged 52 and 91, respectively, in groups 1 and 2. The average number of acid reflux in group 1 was 4.36, in group 2 40.5. The average number of non-acid reflux prevailed in patients of group 2, averaging 58, compared with group 1, where the average was 47. According to the results of high-resolution esophageal manometry, when assessing the structure and function of the esophageal-gastric junction, violations were detected in 6 out of 17 patients. Disorders of the motor function of the thoracic esophagus were detected in 10 out of 17 patients. The tone of the lower esophageal sphincter in group 1 patients was significantly higher in comparison with patients in group 2. Conclusion. A number of patients with Barrett's esophagus have insufficient effectiveness of antisecretory therapy, which may not manifest itself clinically and thereby increase the risk of progression. There was a tendency to more frequent motor disorders in the group with insufficient effectiveness of antisecretory therapy, as well as significantly lower tone of the lower esophageal sphincter, which may be a potential predictor of suboptimal effectiveness of antisecretory therapy.

Objective: to evaluate the effectiveness of an esophagoprotector in reducing the risk of recurrent symptoms of gastroesophageal reflux disease (GERD) in patients who requiring temporary cancellation of therapy with proton pump inhibitors (PPIs). Material and methods. For the prospective comparative study there were selectively chose patients who had been taking PPIs for a long time (at least one month) for the underlying disease and who required temporary discontinuation of antisecretory therapy due to objective medical reasons. The study included patients with endoscopically and/or pH-metrically verified GERD, as well as histologically verified Barrett's esophagus. In the process of randomization of patients, two equal groups were formed, depending on the therapy received at the time of PPI withdrawal: group 1 received antacids on demand, group 2 received antacids on demand, as well as the esophagoprotector Alfasoxx at a dose of 10 ml four times a day (after each meal and at night). The follow-up period was two weeks. The patients recorded episodes of heartburn in their personal diaries. Results. The study included 60 patients (28 men and 32 women). The average age of the examined patients was 43.1 ± 5.3 years. By the end of the two-week follow-up period, the frequency of recurrent symptoms in group 1 was 36.7%, while in group 2 it was 13.3%. The use of the esophagoprotector Alfasoxx contributed to the significant regression of the risk of heartburn recurrence (odds ratio 0.2657; 95% confidence interval (CI) 0.07328-0.9637; p = 0.0438) in comparison with the group of patients who received only antacids in the on-demand mode. When analyzing the population of patients who had relapsed symptoms, it was demonstrated that the average number of heartburn episodes in group 1 was 6.18 (95% CI 4,1930-8,1706), and in group 2 – 4.50 (95% CI 0,7121-8,2879). Conclusion. This prospective comparative study demonstrated that the use of the esophagoprotector Alfasoxx helps to reduce the risk of relapse of GERD symptoms in patients requiring temporary cancellation of PPI therapy.