Гастроэзофагеальная рефлюксная болезнь (ГЭРБ) по распространенности занимает 1-е место среди гастроэнтерологических заболеваний. ГЭРБ может проявляться и внепищеводными (атипичными) симптомами, к которым относятся: кардиальные, легочные, оториноларингологические и стоматологические симптомы. В ряде случаев внепищеводные проявления могут выходить на передний план в клинической картине. Более того, в 25% случаев ГЭРБ клинически протекает только с внепищеводными симптомами, что укладывается в рамки одной из главных особенностей современной реальной клинической практики: различные заболевания все более утрачивают свой мононозологический характер, приобретая статус коморбидности и мультиморбидности. Наличие внепищеводных симптомов у пациентов с ГЭРБ обусловлено экстраэзофагеальным (или, точнее, гастроэзофаголарингофарингеальным) рефлюксом, который в международной медицинской литературе обозначается как ларингофарингеальный рефлюкс (ЛФР). В настоящее время ЛФР рассматривается как состояние воспаления слизистой оболочки верхних отделов пищеварительного и респираторного трактов, связанное с прямым и непрямым (рефлекторным) воздействием гастродуоденального рефлюктата, которое может вызывать морфологические изменения слизистой оболочки. За последнее десятилетие сформировались два подхода к лечению ЛФР. Первый подход включает, наряду с диетотерапией и модификацией образа жизни, использование ингибиторов протонной помпы (ИПП) в виде монотерапии. Второй комплексный подход к терапии ЛФР предполагает двойную (ИПП + альгинат/антацид или ИПП + прокинетик) или тройную терапию (ИПП + альгинат/антацид + прокинетик). В обзоре приведены оба подхода к лечению ЛФР, рассмотрены возможности альгинатов в лечении ЛФР.
Gastroesophageal reflux disease (GERD) ranks first among gastroenterological diseases in terms of prevalence. GERD can also manifest with extraesophageal (atypical) symptoms, which include: cardiac, pulmonary, otorhinolaryngological and dental symptoms. In some cases, extraesophageal manifestations can come to the fore in the clinical picture. Moreover, in 25% of cases, GERD clinically occurs only with extraesophageal symptoms, which fits into one of the main features of modern real clinical practice – various diseases are increasingly losing their mononosological character, acquiring the status of comorbidity and multimorbidity. The presence of extraesophageal symptoms in patients with GERD is due to extraesophageal (or, more precisely, gastroesophagolaryngopharyngeal) reflux, which is referred to in the international medical literature as laryngopharyngeal reflux (LFR). Currently, LFR is considered as a condition of inflammation of the mucous membrane of the upper digestive and respiratory tracts associated with direct and indirect (reflex) effects of gastroduodenal refluctate, which can cause morphological changes in the mucous membrane. Over the past decade, two approaches to the treatment of LFR have emerged. The first approach involves the use of proton pump inhibitors (PPIs) as monotherapy along with dietary and lifestyle modification. The second comprehensive approach to LFR therapy involves dual therapy (PPI + alginate/antacid or PPI + prokinetic) or triple therapy (PPI + alginate/antacid + prokinetic). In this review, both approaches to the treatment of LFR are considered, and the possibilities of alginates in the treatment of LFR are considered.
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Авторы
Д.И. Трухан*1, Н.А. Чусова2, О.В. Дрокина1
1 ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*dmitry_trukhan@mail.ru
________________________________________________
Dmitry I. Trukhan*1, Natalia A. Chusova2, Olga V. Drokina1
1 Omsk State Medical University, Omsk, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*dmitry_trukhan@mail.ru