gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2019-29-4-66-73gastro-j-345Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГИИ, ГЕПАТОЛОГИИNATIONAL COLLEGE OF GASTROENTEROLOGY, HEPATOLOGYГастроэзофагеальная рефлюксная болезнь и ишемическая болезнь сердца — существует ли синдром взаимного отягощения?Gastroesophageal Reflux Disease and Coronary Heart Disease: Is There a “Mutual Burden” Syndrome?АлексееваО. П.AlekseevaO. P.

доктор медицинских наук, профессор, профессор кафедры госпитальной терапии им. В.Г. Вогралика 

603005, Нижний Новгород, пл. Минина и Пожарского, д. 10/1

Dr. Sci. (Med.), Prof., Department of Hospital Therapy named after V.G. Vogralik

603005, Nizhny Novgorod, Minin and Pozharsky square, 10/1

al_op@mail.ruПикулевД. В.PikulevD. V.

кандидат медицинских наук, доцент, доцент кафедры госпитальной терапии им. В.Г. Вогралика

603005, Нижний Новгород, пл. Минина и Пожарского, д. 10/1

Cand. Sci. (Med.), Assoc. Prof., Department of Hospital Therapy named after V.G. Vogralik

603005, Nizhny Novgorod, Minin and Pozharsky square, 10/1

ФГБОУ ВО «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияPrivolzhsky Research Medical UniversityRussian Federation2019090620192946673Copyright © Алексеева О.П., Пикулев Д.В., 20192019Алексеева О.П., Пикулев Д.В.Alekseeva O.P., Pikulev D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/345

Цель обзора: представить данные о взаимном отягощающем влиянии на течение гастроэзофагеальной рефлюксной болезни (ГЭРБ) и ишемической болезни сердца (ИБС).Основные положения. Сочетание ИБС и ГЭРБ является распространенной клинической ситуацией. В последние годы появляется все больше информации, свидетельствующей о неслучайности сосуществования обоих заболеваний. Помимо общих факторов риска, установлен целый ряд патофизиологических механизмов, обуславливающих патогенетическую связь ИБС и ГЭРБ. Рефлюксная болезнь вносит неблагоприятный вклад в течение хронической ИБС, в том числе повышая риск развития инфаркта миокарда (ИМ). Доказано совпадение эпизодов ишемии миокарда на ЭКГ с эпизодами изжоги, выявлена корреляция патологического рефлюкса и депрессии сегмента ST, показана триггерная роль рефлюкса в отношении приступов стенокардии и нарушений сердечного ритма. Проаритмические влияния ГЭРБ на миокард объясняются дисбалансом вегетативной нервной системы с преобладанием парасимпатического тонуса. В свою очередь, как стабильная стенокардия, так и перенесенный ИМ способствуют более агрессивному и рефрактерному течению рефлюкс-эзофагита (РЭ) и являются триггерами возникновения рефлюксных симптомов.Заключение. В основе коморбидного течения ИБС и ГЭРБ лежат сложные ассоциации, эта клиническая ситуация характеризуется синдромом взаимного отягощения. Учитывая высокую распространенность сочетания обоих заболеваний, представляется актуальной выработка патогенетически обоснованных подходов к ведению данной категории пациентов.

Aim. This review aims to generalize data on the mutual aggravating effect on the course of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).General findings. The combination of CHD and GERD is a common clinical situation. In recent years, more and more information has appeared indicating a non-accidental character of the comorbidity of both diseases. In addition to common risk factors, a number of pathophysiological mechanisms have been established that determine a pathogenetic relationship between CHD and GERD. Reflux disease contributes adversely to chronic coronary heart disease, e.g. by increasing the risk of developing myocardial infarction (MI). The co-occurrence of myocardial ischemia episodes (registered by ECG) with those of heartburn has been identified. A correlation between pathological reflux and ST segment depression has been found. A trigger role of reflux in relation to angina attacks and heart rhythm disturbances has been determined. The pro-arrhythmic effects of GERD on the myocardium are explained by an imbalance of the autonomic nervous system with a predominance of the parasympathetic tone. In turn, both stable angina and myocardial infarction contribute to a more aggressive and refractory course of reflux esophagitis (RE), thus triggering reflux symptoms.Conclusion. The comorbid course of coronary heart disease and GERD is based on complex associations; this clinical situation is characterized by a mutual burden syndrome. Given the high prevalence of a combination of both diseases, it seems relevant to develop pathogenetically substantiated approaches to the management of this category of patients.

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The authors declare that there are no conflicts of interest present.