APPROACH TO TREATMENT OF PATIENTS WITH SLIDING HIATAL HERNIA WITH UNDERLYING REFLUX ESOPHAGITIS
Sliding hiatal hernia combined with reflux esophagitis - it's a widespread multifactorial recurrent disease. Purpose - improvement of results of treatment of patients with sliding hiatal hernia with reflux esophagitis by means of rational choice of the treatment method considering the presence of the connective tissue undifferentiated dysplasia syndrome. Materials. The examination of 238 patients with sliding hiatal hernia with reflux esophagitis has been performed. (80 patients - conservative treatment, 153 patients - surgical treatment). 40 of patients were examined to reveal the presence of undifferentiated dysplasia of connective tissue. Supplementary diagnostic techniques - the scheme of of T. Milkowska-Dimitrova and A. Karkashov (1987), roentgenoscopy, esophagogastroduodenoscopy. Results. There is a direct correlation between the degree of the severity of phenotypic manifestations of undifferentiated dysplasia of connective tissue and the severity of reflux esophagitis (r=0,998). The quantity of recurrences of reflux esophagitis during a year after the treatment - 38% (p>0.05).The recurrences of reflux esophagitis appeared more often ant patients with the 3 degree of severity of undifferentiated dysplasia of connective tissue. We have revealed the increase of recurrences of reflux esophagitis according to the degree of severity of dysplasia (r=0.923, р=0.88). The have established a direct correlation between the choice of the treatment method and the quantity of recurrences of reflux esophagitis (in case of drug therapy - 47.5%, in case of surgical treatment - 26,9% (r=0.743). Conclusions. Treatment of patients with a sliding hiatal hernia and 0 or I degree reflux esophagitis with the presence of phenotypic signs of I-II degree undifferentiated connective-tissue dysplasia should start with medication. In case of II-III degree reflux esophagitis complex medicinal therapy should be used for 8-12 weeks. In the absence of the effect of medical therapy it is reasonable to resort to surgical treatment. Indication for surgical treatment is existence of severe undifferentiated connective-tissue dysplasia in patients with sliding hiatal hernia and severe reflux esophagitis.