FEATURES OF DIAGNOSTICS AND TREATMENT OF PATIENTS WITH REFLUXESOPHAGITIS ON THE BACKGROUND OF SLIDING DIAPHRAGM HERNIAS

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FEATURES OF DIAGNOSTICS AND TREATMENT OF PATIENTS WITH REFLUXESOPHAGITIS ON THE BACKGROUND OF SLIDING DIAPHRAGM HERNIAS Xamidov Obid Abduraxmanovich, Nurmurzaev Zafar Narbay ugli, Davrаnov Ismoil Ibragimovich, Kim Tatyana Pavlovna, Iskandarova Sabina Xasan kizi, Zarpullayev Javohir Salimjon ugli. Samarkand State Medical University. Samarkand, Uzbekistan. https://doi.org/10.5281/zenodo.11122280 Abstract: Research is ongoing to study the complex defense response of metocestodes, aimed at changing the host's immune response and preventing their elimination, in which the parasite minimizes the impact of the immune system by producing immunomodulatory molecules, thereby interfering with the activity of the complement system, changing the functioning of leukocytes, or using the phenomenon of molecular mimicry. Of particular priority are the issues of studying climatic, geographical, social and economic conditions on the formation of zoonotic foci with varying degrees of intensity of epizootic processes, due to the fact that the incidence of hydatid disease in people is directly proportional to these risk factors. Keywords: hepatocytes, zoonotic foci, echinococcus, liver.

ОСОБЕННОСТИ ДИАГНОСТИКИ И ЛЕЧЕНИЯ БОЛЬНЫХ РЕФЛЮКСЭЗОФАГИТОМ НА ФОНЕ СКОЛЬЗЯЩИХ ГРЫЖ ДИАФРАГМЫ Аннотация: Продолжаются исследования по изучению комплексного защитного ответа метоцестод, направленного на изменение иммунного ответа хозяина и предотвращение их элиминации, при котором паразит минимизирует воздействие иммунной системы, вырабатывая иммуномодулирующие молекулы, тем самым вмешиваясь в активность комплемента. системы, изменяя функционирование лейкоцитов, или используя феномен молекулярной мимикрии. Особую актуальность приобретают вопросы изучения климатических, географических, социальных и экономических условий формирования зоонозных очагов с различной степенью интенсивности эпизоотических процессов, в связи с тем, что заболеваемость людей эхинококкозом прямо пропорциональна этим факторам риска. Ключевые слова: гепатоциты, зоонозные очаги, эхинококк, печень.

INTRODUCTION Currently, there is an increase in the number of patients suffering from refluxesophagitis and HH. The most common method of surgery for this pathology is various fundoplication methods, and the purpose of antireflux correction in HHH is to restore the anatomical and functional state of the esophago-gastric junction and create an adequate antireflux barrier. MATERIAL AND METHODS Our clinic has experience in performing 83 antireflux surgeries for sliding hiatal hernia (HSPH). Of these, 1 (1.2%) patients were diagnosed with the presence of Barrett's esophagus, and 11 (13.2%) patients had a complicated course of refluxesophagitis in the form of peptic esophagitis, cicatricial esophageal strictures. To select the most adequate method for correcting SHPD, all patients underwent a measurement of the esophageal opening of the diaphragm (PF) using ultrasound balloonography. In addition, at the intraoperative stage, we measured the POD value using esophagogastric probes of various diameters.

RESULTS If the POD dimensions did not exceed 35 mm, the purpose of antireflux corrections was to create a mechanical pulp or cuff using the Nissen or Tupe methods. In the case of a greater expansion of the POD, antireflux fundoplication was supplemented with cruroraphy. In connection with the weakness of the ligamentous apparatus of the diaphragm, in 11 (13.2%) patients, alloplasty with a mesh explant was performed and fixed with interrupted sutures. In the case of a history of concomitant diseases, simultaneous interventions were performed. In the early postoperative period, complications were noted in 12 (14.5%) patients. Thus, transient persistent postoperative dysphagia was detected in 8 (9.6%) patients, which was arrested conservatively. Findings. In connection with the development of scientific and technical progress and the introduction of modern technologies in surgical practice, the diagnosis of hiatal hernia, as well as the selection of patients for antireflux treatment with sliding hiatal hernia, should be carried out exclusively according to strict indications based on the data of a comprehensive laboratoryinstrumental examination. At the same time, the volume and technique of surgical intervention should be based on objective data obtained both before the operation and studied intraoperatively. The introduction of minimally invasive laparoscopic technologies in the surgical treatment of HHHPD helps to reduce the time of postoperative rehabilitation of patients, to reduce the number of complications, as well as to improve the quality of life in the long-term period. CONCLUSION Diagnosing and managing reflux esophagitis in patients with sliding diaphragmatic hernias present unique challenges that necessitate a tailored approach. The diagnostic process should include a comprehensive evaluation of symptoms, endoscopic findings, and imaging studies, with particular attention to identifying the presence and severity of esophageal reflux and associated complications such as Barrett's esophagus or strictures. Treatment strategies should aim to address both the underlying anatomical defect and the symptoms of reflux. Lifestyle modifications, including dietary changes, weight management, and elevating the head of the bed, can provide symptomatic relief. Pharmacological interventions, such as proton pump inhibitors and prokinetic agents, are effective in reducing acid secretion and improving esophageal motility. However, surgical intervention may be necessary in cases of severe or refractory symptoms, with laparoscopic fundoplication being the preferred approach for most patients. Multidisciplinary collaboration between gastroenterologists, surgeons, and radiologists is essential for optimizing patient care. Long-term management should focus on regular monitoring for disease progression, symptom control, and addressing any complications that may arise. By implementing a comprehensive and individualized treatment plan, clinicians can effectively manage reflux esophagitis in the setting of sliding diaphragmatic hernias, improving patients' quality of life and reducing the risk of complications.

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