Morphological features of upper gastrointestinal tract lesions in gastroesophageal reflux disease in patients with metabolically associated fatty liver disease, possibilities for correction

Abstract

Introduction. Research into the characteristics of upper gastrointestinal tract damage in patients with metabolic-associated fatty liver disease (MAFLD) is particularly relevant. The purpose of the study: to investigate the morphological changes in the gastric mucosa (GM) in patients with MAFLD and gastroesophageal reflux disease (GERD) and their dynamics during treatment. Object and research methods. Eighty-four patients with MAFLD and GERD were examined. The study was conducted in two stages. In the first stage, patients underwent endoscopic examination followed by morphological assessment of the stomach mucosa and detection of Helicobacter pylori (HP). The body mass index (BMI) was also determined. In the second stage, HP-negative patients with MAFLD and GERD (n= 34) were prescribed therapy with a proton pump inhibitor and rebamipide. Research results and their discussion. It was found that 50 (59.5%) patients with MAFLD and GERD were infected with HP, while 34 (40.5%) patients had no Helicobacter infection. In the absence of HP infection, GERD in patients with MAFLD is more often combined with reflux gastritis (29.4% of cases – p<0.05), as well as erythematous gastropathy (in 41.2% of patients, respectively – p<0.01), while among HP-positive patients, erosive gastritis (24.0% – p<0.05) and erosive-hemorrhagic and erosive-papular gastropathies (in 22.0% and 16.0% of patients) were significantly more common. In the vast majority of patients with MAFLD and GERD, gastric lesions in histological examination more often correspond to grade 2-3 inflammation, especially in erosive-papular and erosive-hemorrhagic gastropathies, as well as in reflux gastritis. Conclusions. 1. In 59.5% of patients with MAFLD and GERD, HP infection was diagnosed, which is associated with a more pronounced increase in BMI in these patients. 2. Endoscopic examination of HP-negative patients with MAFLD and GERD more often revealed erythematous gastropathy (in 41.2% of patients – p<0.01) and reflux gastritis (in 29.4% of patients – p<0.05). 3. Additional administration of rebamipide is an effective method for reducing the severity of gastric mucosal inflammation in patients with GERD and MAFLD.