HISTOLOGICAL EXAMINATION OF THE ESOPHAGUS MUCOSA DURING COMPLICATIONS OF GASTROESOPHAGEAL REFLUX DIEASE

Diagnosis of complicated gastroesophageal reflux disease (CGERD) is rather complicated due to the absence of a "gold standard" for recognizing the disease, as well as the existence, besides typical complications of GERD (esophageal bleeding, ulcer, stricture, and metaplasia), many extra-esophageal manifestations (chronic bronchitis, bronchial asthma, and coronary heart disease). The large and giant hiatal hernias (HH) are associated with gastroesophageal reflux disease (GERD) at 50-95% and constitute a high risk of compression of the mediastinum, swirling, necrosis and perforation of the stomach. Metaplastic changes of the flat epithelium of the esophagus to the cylindrical (Barrett's esophagus) are triggered by inflammation and damage to the esophagus mucosa, caused by chronic reflux of the gastric contents. The Barrett's esophagus is present in 1.05 % of the total population, 8.6 % of patients with symptomatic GERD and 10.8 % of those who suffered from antireflux operations. This condition is associated with a significantly elevated (approximately 100-fold) risk of adenocarcinoma of the esophagus compared with the general population. The results of treatment of 54 patients with CGERD, which were treated at the Department of Surgery and Endoscopy of the Faculty of Postgraduate Education of the Lviv National Medical University from 2016-2018 have been analysed. The place of histological evaluation of the structure of the esophagus mucosa for the diagnosis of upper hypertension was determined. In order to analyze histological characteristics depending on the survey data and endoscopy, patients were divided into 3 groups: I - patients without clinical and endoscopic signs of GERD; II - patients with endoscopic signs of GERD (hiatal hernia, getting into the esophagus stomach contents and / or duodenal ulcer, redness, swelling distal SOS, fibrin layers), but without any complaints that could be associated with CGERD; III - CGERD patients (ulcer, stricture, bleeding). The most important criteria CGERD were selected: hyperplasia of the basal layer of the epithelium, swelling and separation of the epithelium, epithelial infiltration of eosinophils or neutrophils.