Complicated gastroesophageal reflux disease: diagnosis and treatment

Objective — to analyze the results of diagnosis and treatment of complicated gastroesophageal reflux disease. Materials and methods. A retrospective analysis of the diagnosis and treatment of 1232 patients with complicated GERD treated at the Department of Surgery, Plastic Surgery and Endoscopy Lviv National Medical University, Lviv Regional Clinical Diagnostic Center and Lviv territorial medical union multidisciplinary clinical hospital of emergency and intensive care in the period of 2018 to 2023 years. The analysis involved 690 women (56%), and 542 men (44%). The mean patients’ age was 57.0±4.5 years, the mean body mass index 32.7 kg/ m2. Analysis included complaints and patient history, duration of symptoms, instrumental studies (esophagogastroduodenoscopy, X‑ray of the gastrointestinal tract with barium sulfate), various methods and techniques of operations. Statistical analysis was made with Statistica 10.0 (StatSoft). Results. Patients with peptic ulcer of the esophagus received proton pump inhibitors, prokinetics. Laparoscopic antireflux surgery was performed at 4 ‑16 weeks after conservative treatment. Balloon dilatation and conservative treatment for 12 weeks was performed in 4 patients with peptic stricture of the esophagus. Argon plasma coagulation and/or radiofrequency ablation was performed in 9 patients with verified Barrett’s esophagus, PPIs were used for 8 ‑ 12 weeks before surgery in all patients and in 2 cases after it. In 10 patients with acute bleeding from the upper parts of the digestive tract, combined hemostasis (injection + argon plasma coagulation) was performed in combination with infusional hemostatic, anti‑ulcer therapy. Laparoscopically was performed for 105 patients. Conclusions. Among GERD complications, esophageal‑gastric bleeding was diagnosed in 14.3% of patients, hiatal hernia in 90.5%, Barrett’s esophagus with columnar­lined esophagus CLE in 7.9% of patients. Performance of combined hemostasis (injection + argon plasma coagulation) in combination with infusional hemostatic and anti‑ulcer therapy made it possible to stop bleeding and prepare patients for planned surgical intervention.