Prognostic analysis of factors affecting the outcome of the initial course of antisecretory therapy in patients with gastroesophageal reflux disease and obesity against the background of type 2 diabetes
Introduction: Despite the widespread use of highly informative research methods, a high frequency of ineffectiveness of standard antisecretory therapy is revealed, due to insufficient knowledge of the factors affecting therapy with proton pump inhibitors. The purpose of the study: to identify possible factors of inefficiency of the initial course of antisecretory therapy in patients with gastroesophageal reflux disease and obesity against the background of type 2 diabetes. Material and methods: after 12 weeks, according to the results of drug therapy, not all patients received a complete response, so multiple regression analysis was used to determine predictor indicators and search for the dependence of an adverse outcome. Results: when 3 factors are combined, such as the number of refluxes with a pH<4, the bolus exposure at 15 cm, the resting pressure of the NPS, the percentage of ineffective therapy is 43%, p<0.07. When 4 factors are combined: the number of refluxes with pH<4, bolus exposure by 15 cm, rest pressure of the NPS, total relaxation-56%, at p<0.00021, but when combined with such factors as the number of refluxes with pH<4, rest pressure of the NPS, total relaxation and the results of the GERD-Q questionnaire, the percentage of inefficiency increases sharply and reaches 92%, at p<0.0000. It was found that when combined with 5 factors: the number of refluxes with pH<4, bolus exposure by 15 cm, resting pressure of the NPS, total relaxation and the results of the GERD-Q questionnaire, the inefficiency of therapy is 93%, at p<0.0000. Conclusions: if at least 3 risk factors are identified for an incomplete response to standard antisecretory therapy at the screening stage, in patients with gastroesophageal reflux disease and obesity against the background of type 2 diabetes, it leads to a decrease in the effectiveness of the initial course of therapy, which requires the appointment of long-term therapy for a period of 24 weeks or more.