GASTROESOPHAGEAL REFLUX DISEASE: PSYCHOSOMATIC ASPECTS

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The purpose of the study was to investi-gate the frequency and intensity of cognitive and emotional disorders of vegetative dysfunc-tions, serotonin secretion in patients with gastroesophageal reflux disease (GERD) in terms of the evaluation of their influence in the course of disease. Materials and methods: in a cross-section open examination of 71 patients with GERD lasted for 2 years, non-erosive reflux dis-eases (NERD) was revealed in 42 patients, re-flux esophagitis (RE) was revealed in 29 patients. Diagnosis was established on the basis of history taking, clinical study, fibrogastroduodenoscopy, pH-metry. We have carried out vegetative probes (сardiointervalography, orthoclinostatic and cold test), and patient testing using a scale of situa-tional and personal anxiety of C.D. Spielberg modified by Yu.L. Khanin, methods of indices and forms of aggression diagnostics of A. Buss and A. Durkey adapted by A.K. Osnitsky, clinic inventory for the revelation and evaluation of neurotic conditions (K.K. Yakhin, D.M. Medndelevich), Toronto Alexithymia Scale of G. Taylor adapted in V.M. Bekhterev Psychoneurological Research Institute in 1994, method of subjective control level (SCL) based on a J.B. Rotter’s scale (1999), personal inventory of B.M. Bekhterev Institute (PIBI), detection of serotonin level in blood. Statistic processing of the data was carried out using a Statistica 6.0 program for Windows with nonparametric methods: χ2 with Yates’s correc-tion, and a Spearman’s criterion. Results: while studying the neurotic conditions, we have noted the prevalence of the following characteristics in the GERD patients. 20% of them had defects on 6 scales of inventory, 12 people had no defects (17%), and the rest of the patients had defects on 1-5 scales of the inventory. Alexithymia was revealed in 26 people (38%), and average indices of subscales of person’s locus control were in the zone of external level, more signified indices were in a sphere of misfortunes and interpersonal relations. Situation and personal anxiety of the majority of the patients was in the zone of high (57%) or moderate level (41%). We have also revealed the prevalence of aggressiveness over the animosity. We encountered independent types of patient’s reaction on the diseases as well as in combination: harmonic in 7% of patients, anxious in 38% of patients, obsessive and phobic in 32% of patients, sensitive in 23%, egocentric in 8%, euphoric in 17%, anosognosic in 17%, ergopathic in 20%, paranoic in 25% patients. We have determined the variability of the serotonin level. It amounted to (LQ, UQ) from 213.26 to 283.10 ng/ml. While studying the vegetative tone of patients with GERD we have diagnosed eutony in 58 (82%) people, sympathetic tone domination in 8 people (11%), and parasympathetic in 5 people (7%). The research for vegetative reactivity of patients with GERD allowed the isolation of normal reaction in 58 (82%), higher reaction in 8 (11%), and perverted reaction in 5 (7%) patients. Normal vegetative support of activity was encountered in 6 patients with RE (21%), defected vegetative support in 23 (79%) people. Among patients with NERD normal vegetative support was diagnosed in 31 people (74%), defected support in 11 patients (26%). Defected vegetative support of activity was more often associated with RE, situational anxiety and anxious type of behavior in the course of disease. Alexithymia, internal level in the sphere of achievements, health, general index of neurotic reaction, asthenia scale, aggressiveness index, physical aggression, suspiciousness, situational and personal anxiety rates, level of serotonin in blood (p<0.05). Conclusions: a part of the patients with GERD has a high frequency of cognitive and emotional defects, associated with the defected vegetative support of activity with low rate of serotonin in blood serum.