COMPARATIVE STUDY OF THE COMBINATION OF REBAMIPIDE AND OMEPRAZOLE WITH OMEPRAZOL MONOTHERAPY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE AND CHOLECYSTECTOMY
Abstract
Objective: to study the clinical and morphological features of the esophagus in patients with cholecystectomy, to study the features of immunohistochemical expression of Ki-67, CDX2, VEGF, CD34, CD95. Materials and methods. 46 patients with indications for elective cholecystectomy and a concomitant diagnosis of gastroesophageal reflux disease were included. Of the 46 patients, 59 % are women (n = 27) and 41 % are men (n = 19). The mean age was 38.7 ± 5.5 years. Before surgery, fibrogastroduodenoscopy with biopsy sampling was performed. After cholecystectomy, depending on the therapy, the patients were divided into two groups: group 1 (Omeprazole 20 mg 2 times a day for 3 months), group 2 (Omeprazole 20 mg 2 times a day and Rebamipide (Rebagit) 100 mg 3 times a day 3 months). 12 months after cholecystectomy, fibrogastroduodenoscopy was performed with biopsy sampling. The characteristic symptoms of gastroesophageal reflux disease were assessed over time using the GerdQ questionnaire. Histological evaluation of biopsy samples of the esophageal mucosa with immunohistochemical evaluation of the expression of the Ki-67 proliferation marker, CDX2 transcriptional disease, VEGF vascular endothelial inflammation, CD34 and CD95 growth markers was performed. Results. In group 1, there were no significant elevated levels of CD95 (p = 0.130) and CDX2 (p = 0.066) expression before and after surgical detection. An increase in the expression of CD34 (p = 0.003), VEGF (p = 0.038) and an increase in the Ki-67 proliferation index (p = 0.003) was revealed statistically. There were no statistically significant changes in the results of the GerdQ score (p = 0.264). In group 2, there were no statistically significant frequencies at the level of expression of CD95, Ki-67, CDX2, CD34 and VEGF (p = 0.802; p = 0.763; p = 0.414; p = 0.527 and p = 0.453, respectively). A statistically significant decrease in the results of the score on the GerdQ questionnaire was revealed (p = 0.038). Conclusions. Increased expression of the proliferation marker Ki-67, vascular endothelial growth of VEGF and CD34 in patients with gastroesophageal reflux disease after cholecystectomy of severe obstruction of inflammatory changes in the esophageal mucosa, which may be associated with an increase in the frequency of bile acids in the damaging effect of refluxate. The appointment of Rebamipide in relation to patients with Omeprazole in patients undergoing cholecystectomy is carried out to accurately determine the values of markers of proliferation and angiogenesis in the epithelium of the esophagus 12 months after surgery for the disease of patients who received Omeprazole in the monotherapy protocol. Also, the use of Rebamipide causes consequences for the final score on the GerdQ questionnaire.
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