METABOLIC FEATURES OF GASTROESOPHAGEAL REFLUX DISEASE IN ADOLESCENTS

The article presents our own research data on the study of metabolic characteristics of adolescents with gastroesophageal reflux disease (GERD), including obese patients. The objective of the study was to assess the metabolic characteristics of non-erosive and erosive clinical forms of GERD in adolescents and justify further differentiated correction of metabolic disorders. Materials and Methods. 35 healthy adolescents (Group I – the controls) and 81 children aged 15–17 years with GERD (Group II – the main group) were examined, including 47 patients with non-erosive reflux disease (NERD) (Subgroup IIn) and 34 patients with erosive reflux esophagitis (ERE) (Subgroup IIe), including 9 obese girls. Metabolic features were studied by measuring the levels of 78 organic acids (OA) in urine using gas chromatography-mass spectrometry (GC-MS). The obtained results were statistically processed using generally accepted methods of medical statistics. Results. Every 10th patient with GERD had lipoic acid and vitamins B1, B2, B3, and B5 deficiency, while 48.7% of adolescents with NERD and 2/3 of patients with ERE had vitamin B6 deficiency. An elevated orotate level (a biomarker of magnesium deficiency) was found in every third patient in Subgroup IIn and in 64.7% of patients in Subgroup IIe, which was also confirmed by the indicators of other metabolites (lactate, pyruvate, succinate, citrate, 2-ketoglutaric acid). Patients with GERD (29.8% and 52.9% in Subgroups IIn and IIe) significantly more often had elevated levels of hydroxyproline dipeptide (a marker of bone and connective tissue disorders), which were 2 times higher in ERE patients vs. NERD patients and 3 times higher in ERE patients vs. the controls. In 42.6% of patients with NERD and 85.3% of patients with ERE, especially in those with obesity (88.9%), metabolic markers of intestinal microbiome disorders were detected. They can support the inflammatory process in the esophageal mucosa and contribute to the disease's progression and require appropriate correction. Conclusion. In adolescents with non-erosive and erosive forms of GERD, especially if accompanied by obesity, a complex of metabolic disorders in carbohydrate, protein, and fat metabolism was identified, which requires further study and differentiated correction. The non-invasive GC-MS screening method used to measure urinary OА levels makes it possible to identify the main metabolic disorders in GERD in adolescents, allowing differential correction of disease therapy and control of its effectiveness and duration.