Differential diagnostics and comparative results of complex treatment of patients with erosive and erosive-ulcer esophagitis

Moroshek Anton Aleksandrovich

To assess the possibility of using a histological study for the differential diagnosis of erosive-ulcerative esophagitis and erosive esophagitis by assessing the operational characteristics of the method in identifying erosive-ulcerative esophagitis in patients with erosive esophagitis. To substantiate the feasibility of using the comprehensive treatment algorithm (СТА), which is based on the performance of antireflux surgery, in patients with erosive-ulcerative esophagitis by comparing the safety and effectiveness of using the СТА in patients with erosive-ulcerative and erosive esophagitis. Materials and methods. The study was carried out on samples of 19 patients with erosive-ulcerative esophagitis (main group) and 282 patients with erosive esophagitis (control group). At the diagnostic stage, endoscopy, histological examination of mucosal samples and X-ray contrast study were used. At the stage of treatment - therapy with proton pump inhibitors and antireflux surgery. Results. Histological examination in patients with erosive esophagitis in order to identify erosive-ulcerative esophagitis, according to our data, has very high operational characteristics (sensitivity – 89.4% (95% CI 76.9% -96.5%), specificity – 99.5% (95% CI 98.1% – 99.9%)). There were no statistically significant differences between the study and control groups in the incidence of perioperative complications. Excellent and satisfactory long-term results of treatment were achieved in 94.7% (95% CI 74% - 99.9%) of patients with erosive-ulcerative esophagitis. There were no statistically significant differences in the results of treatment between patients in the main and control groups. Conclusion. Histological examination can serve as a valuable method of clarifying and differential diagnosis of erosive-ulcerative esophagitis. Safety and efficacy (including in comparison with those in patients with erosive esophagitis) make it possible to recommend the CTA, including antireflux surgery, for the treatment of patients with erosive-ulcerative esophagitis.

Keywords:treatment of GERD complications; diagnosis of GERD complications; antireflux surgery; erosive reflux esophagitis; erosive-ulcerative esophagitis.