Peculiarities of clinical manifestations and the prevalence of gastroesophageal reflux disease among workers and employees of the oil industry

The dissertation is devoted to the study of the clinical characteristics and prevalence of gastroesophageal reflux disease (GERD) among workers in the oil industry. Based on screening questionnaires and in-depth clinical and instrumental examination, the frequency of esophageal and extraesophageal manifestations of the disease, the ratio of endoscopically negative and positive forms, and the possible association of GERD with working conditions in the oil industry are evaluated. The data obtained are intended to develop recommendations for reducing morbidity and improving the prevention of GERD in this occupational group.

Relevance: The disease characterized by the reflux of gastric contents into the esophagus has been known for a long time. Symptoms such as heartburn and acid regurgitation are mentioned in the works of Avicenna. Gastroesophageal reflux (GER) is believed to have been first described by H. Quinke in 1879 (cited after Grinevich V.B., Bogdanov I.V., Sablin O.A., 2001).

No serious, large-scale epidemiological studies on the prevalence of GERD have been conducted in many countries. Therefore, the true prevalence of this disease is poorly understood. For the most part, patients were examined on a self-referred basis. For example, in Sudan, 59 men and 41 women with suspected GERD were examined in this manner. GERD was identified endoscopically in 47 (45%) patients (Fedail S.S., Mohamed Ahmed N.N., 2001).

In the United States, heartburn—the principal symptom of GERD—is experienced weekly by 10 to 20% of adults (Ruth M., Mansson I., 1991; Isolauri J., Laippala P., 1995; Locke G.R., Fetts L., Talley N., 1997; Galmiche J-P., Galmiche H.R., 2000).

In Germany and Sweden, 1011 people were examined for the presence of GERD by its main symptoms (the survey was conducted by telephone). It turned out that 50% of them had suffered from heartburn of varying degrees during the preceding 5 years, 88% had received antisecretory therapy, and 64% experienced heartburn once a week (Jones R., Horbach S., Sahder P., 2001).

In France, among 5042 people, GERD was identified by gastroenterologists, general practitioners, and physicians of other specialties. Their rates of GERD detection were distributed as follows: 50%, 35%, and 14%, respectively (Caekaertet A., Bretagne J.F., Rey J.F., 2001).

In Finland, out of 3378 examined individuals, patients with GERD symptoms constituted 24.5% (760 persons). Endoscopically positive GERD was found in 33% (254 persons), Barrett's esophagus in 2% (14 persons), and esophageal tumor in 0.4% (3 persons). Annually, endoscopically positive patients with GERD are detected at a rate of 1.6 to 3.8 per 1000 population, Barrett's esophagus at 1.3–3.0 per 10000 population, and esophageal tumors at 0.9–2.4 per 10000 population (Voutilainen M., Kunnamo I., Mintynen T., 2002).

In Western Europe, 30 to 50% of the population suffers from heartburn and regurgitation (Carling L., Brun J., 2002).

The prevalence of GERD in Turkey is considered to be similar to that in highly developed countries (Bor S., Kitapcioglu G., Mandiracoglu A., 2001).

In Thailand, GERD is not as common as in European countries. Among 197 patients with suspected GERD, 94 (47.7%) (48 women and 46 men) complained of heartburn and retrosternal pain; 17 of them had a hiatal hernia, and 31 patients suffered from bronchial asthma (15.7%) (20 women and 11 men) (Chakkaphak S., Petsrikun K., 2002).

In Iran, the prevalence of GERD ranges from 17.4% to 22.7% (Khabbaznia N., Malekzaden R., Nasseri-Moghaddam S., 2002). Such a high level of GERD is believed to be due to the penetration of Western lifestyles into the East.

In Serbia (Sarajevo), the prevalence of GERD increased after the war of 1991–1995 and reached 35–40% (Marie V., Begenisis M., Starovic B., 2002).

Data on the prevalence of GERD in various regions of Russia are very sparse. Thus, in Saint Petersburg, heartburn occurs daily in 4.8%, weekly in 17.8%, and monthly in 23.6% of those surveyed. Of these, 78.3% had never seen a doctor for this complaint. In the age group 16 to 25 years, heartburn was reported by 62.3%; 26 to 35 years by 54.5%; 36 to 45 years by 72.7%; 46 to 55 years by 64.4%; 56 to 65 years by 62.7%; and over 65 years by 62.4% of those surveyed (Starostin B.D., 2001).

Few works demonstrate the frequency of endoscopically negative and positive GERD. P.N. Lyubchenko, J.E. Gaganov, and E.B. Shirokova (2002), in Moscow, determined the prevalence of GERD in a random sample of patients hospitalized in the occupational pathology department not for digestive complaints but for their primary occupational disease. A total of 422 patients were examined. An asymptomatic course was observed in 36 of 121 persons (29.75%). No endoscopic signs of esophagitis were found in 80 patients with lower esophageal sphincter insufficiency (66.12%); non-erosive esophagitis was detected in 29 (23.96%); and erosive esophagitis in 12 (9.92%). Thus, among patients of the occupational pathology department hospitalized regardless of digestive complaints, the frequency of GERD was 28.7%, with one third being asymptomatic.

O.B. Dronova and V.A. Kirillov (2001) examined 52 patients with characteristic clinical manifestations of GERD—heartburn, regurgitation, and symptoms of dysphagia and odynophagia. Endoscopically positive GERD was identified in 42 patients (80.8%), and endoscopically negative in 10 patients (19.2%).

From these two studies, we see an extremely wide range of endoscopically negative and positive GERD, which also requires further investigation.

The prevalence of esophageal and extraesophageal symptoms of GERD has not been studied separately.

In this connection, the aim of the work was to study the characteristics of clinical manifestations and the prevalence of GERD among workers and employees of the oil industry.

To achieve this aim, the following tasks were set:

1. To develop a questionnaire for examining patients in order to identify GERD, to collect screening information, and to conduct a detailed examination of patients suspected of having GERD.

2. To assess the presence of endoscopically negative and positive GERD.

3. To analyze the frequency of esophageal and extraesophageal manifestations of GERD.

4. To provide recommendations for reducing the occurrence of new GERD patients.

Scientific novelty. For the first time, on a large clinical material and using modern methods, the characteristics of clinical manifestations and the prevalence of GERD among workers and employees of the oil industry have been studied. The frequency of endoscopically negative and positive GERD has been examined. The prevalence of esophageal and extraesophageal manifestations of this pathology has been shown. A dependence of GERD on working conditions has been revealed.

Practical significance. The obtained data on the prevalence of GERD among oil-industry workers make it possible to introduce certain recommendations for reducing the occurrence of new cases of this serious disease. Statements submitted for defense.

1. Questionnaires overestimate the assessment of GERD prevalence.

2. Pure GERD, without extraesophageal manifestations, occurs more often among employees than among workers.

3. In men, cardiac symptoms occur more frequently than pulmonary ones. In none of the cases, upon thorough examination, were ENT manifestations detected in men.

4. In women, GERD most frequently occurs under the "mask" of pulmonary manifestations, and only among workers.

5. GERD under the "mask" of cardiac manifestations appears at a reliably older age in male workers than in women. GERD under the "mask" of pulmonary manifestations occurs at an older age in women.

6. In persons with confirmed GERD, dental manifestations are frequently detected.

Publications.

On the topic of the dissertation, 9 scientific works have been published (4 abstracts, 4 journal articles), including one methodological manual for physicians. A certificate for a rationalization proposal No. 802/56 dated 21.01.03 has been obtained.

Implementation in practice.

The results of the study have been implemented in the practical activity of the Medical Sanitary Unit of OAO "Tatneft" and the city of Almetyevsk. The data obtained in the dissertation are used in the educational process at the Department of Therapy, the Department of Family Medicine and Therapy at the State Educational Institution of Additional Professional Education "Kazan State Medical Academy of the Ministry of Health and Social Development of the Russian Federation," and at the Department of Faculty Therapy of Kazan State Medical University.