Aim. To evaluate the E-cadherin content in the blood plasma of individuals with suffering from both gastroesophageal reflux disease (GERD) and GERD combined with obstructive sleep apnea/hypopnea syndrome (OSAHS).Materials and methods. 120 patients with GERD and/or OSAHS were examined. All the patients underwent esophagogastroduodenoscopy with the biopsy of the lower third of the esophagus in order to perform GERD morphological verification. The diagnostics of respiratory disorders during sleeping was performed using computer pulse oximetry. Group 1 (n = 29) consisted of GERD patients, group 2 (n = 35) of patients with GERD in combination with OSAHS, group 3 (n = 30) of patients with OSAHS, group 4 (n = 26) was the comparison group. The concentration of E-cadherin in the blood plasma was determined using enzyme immunoassay. Results. There were no statistically significant differences in the plasma level of the N-terminal E-cadherin fragment between GERD patients and the comparison group (0.207 (0.128; 0.295) and 0.128 (0.067; 0.281) ng/ml, respectively, p = 0.082). However, the patients with erosive esophagitis were characterized by a higher content of E-cadherin in the blood plasma than those of the comparison group (0.284 (0.176; 0.858) and 0.128 (0.067; 0.281) ng/ml,  respectively, p = 0.03). In patients with GERD and OSAHS, statistically significantly higher plasma concentrations of E-cadherin were observed as compared to GERD patients (0.379 (0.277; 0.538) and 0.2007 (0.128; 0.295) ng/ml,  respectively, p = 0.017). A positive dependence of E-cadherin concentration in the blood plasma on the apnea/hypopnea index was found (r = 0.43, p <0.05).Conclusions. OSAHS negatively affects the state of histoarchitecture of the esophageal mucosa of GERD patients, as evidenced by an increase in N-terminal E-cadherin in the blood plasma and may indicate a loss of E-cadherin in the esophageal mucosa with the development of an impaired function of tight junctions.

Nowadays the morphological features of esophageal mucosa damage in patients with the gastroesophageal reflux disease (GERD) and the obstructive sleep apnea/hypopnea syndrome (OSAHS) are not completely researched.The objective of the study was to determine the morphological features of esophageal mucosa damage in patients with GERD and OSAHS.143 patients underwent esophagogastroduodenoscopy with biopsy of the lower third of the esophagus and respiratory monitoring. Patients were divided into 4 groups: group 1 – patients with GERD, group 2 – patients with GERD and OSAHS, group 3 – with OSAHS, group 4 – comparison group. Morphological examination with morphometric assessment of epithelium thickness, height of connective tissue papillae, internuclear distances and intercellular spaces was performed.Patients with GERD are characterized by a large thickness of the epithelium, higher connective tissue papillae, wider internuclear spaces in epithelium layers, enlarged intercellular spaces in the epithelium of the esophagus in contrast to the patients of the comparison group. Patients with GERD and OSAHS have a more pronounced epithelium thickness and wider internuclear distances in the prickly layer of the epithelium compared with patients with GERD, the high connective tissue papillae with dilated capillaries and signs of microangiopathy, sclerotic changes in the mucosa of the esophagus are determined.The obtained data show that patients with GERD and OSAHS had more pronounced epithelial disorganization in comparison with patients with GERD without OSAHS.

Введение. Статья посвящена изучению распространенности наследственных и многофакторных нарушений соединительной ткани (ННСТ) у пациентов с гастроэзофагеальной рефлюксной болезнью (ГЭРБ) и синдромом обструктивного апноэ/гипопноэ сна (СОАГС). В статье приведены особенности терапии ГЭРБ у пациентов с СОАГС и сопутствующими ННСТ.Цель исследования. Оценить распространенность висцеральных и фенотипических маркеров ННСТ у пациентов с ГЭРБ и/или СОАГС.Материалы и методы. В исследование включено 143 пациента в возрасте от 30 до 60 лет с ГЭРБ и СОАГС, которые были разделены на группы: группа 1 – пациенты с ГЭРБ (n=35), группа 2 – пациенты с ГЭРБ и СОАГС (n=40), группа 3 – пациенты с СОАГС (n=38), группа 4 – группа сравнения (n=30). Всем пациентам выполнялись сомнологическое исследование и эзофагогастро-дуоденоскопия. Оценка наличия ННСТ осуществлялась согласно Национальным клиническим рекомендациям.Результаты. С помощью регрессионного анализа доказана связь ННСТ и ГЭРБ. Установлено, что ГЭРБ ассоциирована с наличием висцеральных маркеров ННСТ. Выявлено, что для пациентов с СОАГС характерны аномалии нижней челюсти. Наличие СОАГС у пациентов с ГЭРБ сопровождается увеличением частоты дуоденогастрального рефлюкса, в связи с чем возникает необходимость коррекции стандартной антирефлюксной терапии.Заключение. ННСТ широко распространены среди пациентов с ГЭРБ и СОАГС, что может указывать на определенный вклад ННСТ в развитие этих заболеваний и диктует необходимость коррекции метаболизма соединительной ткани для профилактики осложнений. Background. The article is dedicated to the study of the prevalence of hereditary connective tissue disorders (HCTD) in patients with gastroesophageal reflux disease (GERD) and obstructive sleep apnea/hypopnea syndrome (OSAHS). In the article, there are described the features of GERD therapy in patients with OSAHS and HCTD.Purpose. To assess the prevalence of visceral and phenotypic markers of HCTD in patients with GERD and/or OSAHS.Materials and methods. 143 patients at the age from 30 to 60 years with GERD and OSAHS were includedinthestudy. Patientsweredividedinto 4 groups: group 1 – patientswith GERD(n=35), group 2 – patients with GERD and OSAHS (n=40), group 3 – with OSAHS (n=38), group 4 – comparison group (n=30). All patients underwent somnological examination and esophagogastroduodenoscopy. The presence of HCTD was assessed using the National clinical guidelines.Results. The relationship between HCTD and GERD was revealed with the help of regression analysis. It was found that the presence of GERD is associated with visceral markers of HCTD. Patients with OSAHS are characterized by the anomalies of the lower jaw. The presence of OSAHS in patients with GERD is accompanied by the increased frequency of duodenogastric reflux, therefore, it is necessary to correct the standard antireflux therapy.Conclusion. HCTDs are widely spread among patients with GERD and OSAHS, which may indicate a certain contribution of HCTD to the development of these diseases, and indicates the need to correct the metabolism of connective tissue for the prevention of complications.