ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 27 of 60
JMBS 2019, 4(6): 194–198
Clinical Medicine

Pathomorphological Aspects of Gastroeshophagal Reflex Disease Diagnostics in Condition of Comorbidity with Hypothyroidism

Reva Т. V., Trefanenko I. V., Shumko G. I., Shuper V. O., Reva V. B.

The current paradigm of gastroesophageal reflux disease diagnosis hinges on the identification of oesophageal mucosal lesions or troublesome symptoms caused by gastro-oesophageal reflux. The primary determinant of mucosal injury is excessive oesophageal acid exposure attributable to anatomical or physiological defects of the oesophagogastric junction and oesophageal peristalsis. Gastroesophageal reflux disease symptoms, however, have multiple potential determinants including the number of reflux episodes, the proximal extent to which the refluxate migrates, the acidity of the refluxate, oesophageal hypersensitivity and cognitive hypervigilance. Consequently, depending on the clinical context, the defining features of gastroesophageal reflux disease can be pathology, physiology or symptomatology. The morphology of gastroesophageal reflux disease depends on the duration of contact between the esophageal mucosa and refluxed stomach contents. Consequently, the amount of refluxed material, frequentсy of reflux occurrence, and quickness of refluxed material clearance are all variables. Endocrine disorders are common, and the effects of endocrine disorders present with a wide range of clinical manifestations. Digestive symptoms or signs may also reveal signs of thyroid disease and, when ignored or underestimated, diagnosis may be delayed and serious consequences may occur. Patients with adult gland thyroid deficiency may cause gastrointestinal manifestations, such as gastroesophageal reflux disease. The purpose of the study was to determine the main pathomorphological features of the course of gastroesophageal reflux disease in the conditions of comorbidity with hypothyroidism. Material and methods. The study the characteristics of morphological changes of the esophageal mucosa in patients with gastroesophageal reflux disease on the background of hypothyroidism. Nature of the histological changes of the esophageal mucosa was assessed using a rating scale of morphological changes of the esophagus and the esophagopatic index. Results and discussion. The combination of gastroesophageal reflux disease and hypothyroidism leads to changes in the course of the disease and the clinical picture, reduces efficiency of treatment and worsens the prognosis. The occurrence of gastroesophageal reflux disease in comorbidity with hypothyroidism complicates the course of the disease and leads to the frequent development of alkaline reflux. In the pathomorphological picture gastroesophageal reflux disease with alkaline reflux marked predominance of hyperregenerative changes over inflammatory of the esophageal mucosa, but when acid reflux, on the contrary, inflammatory infiltration of the epithelium and submucosal layer of the esophagus prevailed over the hyperregenerative changes. The esophagopathic index at alkaline reflux was EPI=2.29 ± 0.08 and at acidic reflux significantly lower EPI = 1.94 ± 0.19 (р<0.05). In patients with gastroesophageal reflux disease with hypothyroidism with alkaline reflux (5 %), cylindrical gastric and specialized intestinal metaplasia were observed mainly on the background of thickened, with spongiosis, stratified squamous epithelium. Conclusion. In cases with Barrett's esophagus, patients with gastroesophageal reflux disease with acid reflux (30 %) with gastric and specialized intestinal metaplasia of stratified squamous epithelium showed subepithelial incendiary polymorphic cell infiltration; stratified squamous epithelium in these cases was also thickened, with spongiosis.

Keywords: gastroesophageal reflux disease, hypothyroidism, comorbidity, morphological changes

Full text: PDF (Ukr) 204K

  1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014; 63(6): 871–80. 304269
  2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006; 101(8): 1900-20.
  3. Katz PO, Gerson LB, Vela MF. Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2013; 108: 308-28.
  4. Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 2016 Aug; 51(8): 751-67. s00535-016-1227-8
  5. Fadeenko GD, Gridnev AE. Gastroezofagealnaya reflyuksnaya bolezn: pishchevodnye, vnepishchevodnye proyavleniya i komorbidnost. Ed by AN Belovol. Kiev: Biblioteka «Zdorovya Ukrainy»; 2014. 376 p. [Russian]
  6. Osadchuk MA, Svistunova AA, Osadchuk MM, i dr. Gastroezofagealnaya reflyuksnaya bolezn` kak mul`tidiscziplinarnaya patologiya. Poliklinika. 2013; 4: 88-96. [Russian]
  7. Prykhodko VIu, Morieva DIu. Osoblyvosti perebihu hastroezofahealnoi refliuksnoi khvoroby u litnikh liudei. Probl starenyia y dolholetyia. 2015; 24(1): 58-77. [Ukrainian]
  8. Centanni M, Benvenga S, Sachmechi I Diagnosis and management of treatment-refractory hypothyroidism: an expert consensus report. J Endocrinol Invest. 2017 Dec; 40(12): 1289-301.
  9. Laurberg P, Andersen S, Bülow Pedersen I, Carlé A. Hypothyroidism in the elderly: pathophysiology, diagnosis and treatment. Drugs Aging. 2005; 22(1): 23-38.
  10. Zhou LY, Wang Y, Lu JJ, Lin L, Cui RL, Zhang HJ, et al. Accuracy of diagnosing gastroesophageal reflux disease by GerdQ, esophageal impedance monitoring and histology. J Dig Dis. 2014; 15(5): 230–8.