Aim. This review aims to generalize data on the mutual aggravating effect on the course of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).General findings. The combination of CHD and GERD is a common clinical situation. In recent years, more and more information has appeared indicating a non-accidental character of the comorbidity of both diseases. In addition to common risk factors, a number of pathophysiological mechanisms have been established that determine a pathogenetic relationship between CHD and GERD. Reflux disease contributes adversely to chronic coronary heart disease, e.g. by increasing the risk of developing myocardial infarction (MI). The co-occurrence of myocardial ischemia episodes (registered by ECG) with those of heartburn has been identified. A correlation between pathological reflux and ST segment depression has been found. A trigger role of reflux in relation to angina attacks and heart rhythm disturbances has been determined. The pro-arrhythmic effects of GERD on the myocardium are explained by an imbalance of the autonomic nervous system with a predominance of the parasympathetic tone. In turn, both stable angina and myocardial infarction contribute to a more aggressive and refractory course of reflux esophagitis (RE), thus triggering reflux symptoms.Conclusion. The comorbid course of coronary heart disease and GERD is based on complex associations; this clinical situation is characterized by a mutual burden syndrome. Given the high prevalence of a combination of both diseases, it seems relevant to develop pathogenetically substantiated approaches to the management of this category of patients.

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.