Epidemiology, clinical manifestations and efficiency of different methods of treatment of acromegaly according to the United Russian Registry of Patients with Pituitary Tumors

BACKGROUND: The registry is the main source of information about patients with acromegaly for assessing the quality of medical care, effectiveness of treatment, determining the compliance of real clinical practice with existing standards and patient management protocols. AIMS: To evaluate epidemiological, demographic and clinical characteristics of acromegaly in Russian Federation and effectiveness of treatment modalities. MATERIALS AND METHODS: The object of the study was the database of the united Russian registry of patients with pituitary tumors with specific analysis of patients with acromegaly only. We analyzed the data of 4114 patients with acromegaly stored on the online system in February 2019. RESULTS: Based on the data 32% of patients had complete clinical and laboratory remission of acromegaly; the percentage of patients with no remission was 68%, among them 22.5% had significant improvements in clinical symptoms and a decrease in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) without IGF-1 normalization. The average age of patients at the onset of the disease was 42.7 years and at diagnosis 45.8 years. The ratio of men to women was 1:2.6. In patients with acromegaly hypopituitarism was registered in 14.7% of cases and among them hypothyroidism (66%) and hypogonadism (52%) were registered more often. Among other complications the leading were diabetes mellitus (15.7%) and acromegalic arthropathy (15%). The proportion of patients receiving neurosurgical treatment increased from 35.7% to 49.6% in 20122019; the portion of patients undergoing radiation therapy decreased significantly from 17.7% in 2012 to 0.8% in 2019. Remission was achieved in 40.47% after neurosurgery and 28.95% after medical treatment as a first line therapy p0.01. The number of patients receiving medical treatment at the time of the study was 1209. Among them 51% of patients treated with long-acting lanreotide and 24% receiving long-acting octreotide achieved remission (p0.0001) CONCLUSIONS: The remission rate of acromegaly remains suboptimal despite increased surgical activity, which corresponds to global trends. Long-acting lanreotide was significantly superior versus long-acting octreotide in the rate of acromegaly remission, which does not correspond with clinical trials.

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The effectiveness of acromegaly treatment according to the Registry of patients with pituitary tumors in the Republic of Tatarstan

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-040 ◽

2020 ◽

Vol 49 ◽

Author(s):

G. R. Vagapova ◽

B. Yu. Pashaev ◽

R. R. Ashimova ◽

A. R. Khafizov ◽

Iu. V. Mokhova

Keyword(s):

Remission Rate ◽

Pituitary Tumors ◽

Treatment Modalities ◽

First Line ◽

Treatment Algorithms ◽

First Line Therapy ◽

Line Therapy ◽

The Republic ◽

Long Acting ◽

Available Information

Background: Acromegaly is a severe progressive neuroendocrine disease caused by chronic elevated concentrations of growth hormone and insulin-like growth factor 1 in individuals with completed physiological growth and leading to early disability and mortality. The Acromegaly Registry with its regular updates makes it possible to merge and systematize all the available information on the diseases, to assess the efficacy of treatment algorithms and to choose an optimal diagnostic and treatment strategy in a given territory.Aim: To evaluate the efficacy of various treatments for acromegaly based on the analysis of the regional Registry of patients with pituitary tumors in the Republic of Tatarstan.Materials and methods: The study was based on data from 217 patients with somatotropin producing pituitary adenomas entered in the Registry of patients with pituitary tumors in the Republic of Tatarstan as per January 2021. One hundred and eighty one (181 patients) with sufficient data to assess the remission rates and the disease course were included into the analysis.Results: Endonasal endoscopic adenomectomy as a first-line treatment has been performed in 93% (169/181) of the patients, with 34% of the cases (57/169) being in the full postoperative remission. The efficacy of surgical treatment depended on the tumor size, invasion grade and aggressiveness. A 1st generation long-acting somatostatin analog (octreotide) has been prescribed to 50% (91/181) of the patients (11 patients as first-line therapy and 80 patients after adenomectomy), with biochemical remission rate of 56% (51/91). Radiological treatment has been completed in 11,6% (21/181) of the patients. The complete remission rate after all treatment modalities (surgical, medical, and radiation therapy) was 60% (108/181).Conclusion: The effectiveness of treatment for acromegaly in the Republic of Tatarstan is comparable to that in the all-Russian and international registries. Nevertheless, 40% of the patients with acromegaly in the region do not have their disease biochemically controlled indicating the need to optimize drug treatment.

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The Results of Giardiasis Treatment Using Giardicidal Drugs and their Combination with Probiotics in Children: A Retrospective Cohort Study

Вопросы современной педиатрии ◽

10.15690/vsp.v17i4.1923 ◽

2018 ◽

Vol 17 (4) ◽

pp. 301-306

Author(s):

Olga G. Kimirilova ◽

Gennady A. Kharchenko

Keyword(s):

Abdominal Pain ◽

Combination Therapy ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Saccharomyces Boulardii ◽

Lactase Deficiency ◽

Intestinal Dysbiosis ◽

Number Of Patients ◽

Freeze Dried ◽

Inpatient Settings

Background. Giardiasis in children remains an urgent problem, the significance of which is determined by the endemicity for many countries and regions, outbreaks of sporadic epidemics, polymorphism of clinical symptoms, and insufficient treatment efficacy. Objective. Our aim was to study the results of giardiasis treatment using giardicidal drugs or their combination with probiotics in children. Methods. We analyzed the frequency of Giardia lamblia elimination (the main outcome) as a result of giardiasis treatment (laboratory confirmed) in children aged from 3 months to 18 years who received giardicidal drugs (nifuratel, albendazole) or their combination with probiotics based on Saccharomyces boulardii (probiotic 1) and live freeze-dried lactic acid bacteria Lactobacillus acidophilus (L. gasseri), Bifidobacterium infantis, and Enterococcus faecium (probiotic 2) in outpatient or inpatient settings. Additionally, we registered the duration of the main symptoms of giardiasis (abdominal pain, diarrhea), the prevalence of intestinal dysbiosis and lactase deficiency. The considering period is from January 2015 to September 2017. Results. The results of giardiasis treatment were studied in 4 groups: monotherapy with nifuratel (n = 65) or albendazole (n = 64), a combination of nifuratel + probiotic 1 (n = 67) or albendazole + probiotic 2 (n = 64). The groups were comparable by sex, age, and clinical manifestations of the disease. The elimination of lamblia on the 14–16th day of monotherapy with giardicidal drugs was achieved in 56–60%, when combined with probiotics — in 84% of patients for each combination (df = 3, p < 0.001). Against the background of combination therapy, the disease symptoms (abdominal pain, diarrhea, vomiting) were reversed 1.5 times faster; the number of patients with lactase deficiency and intestinal dysbiosis decreased two and more times, under monotherapy with giardicidal drugs — 1.2 times (df = 3, p < 0.001). Conclusion. Giardiasis treatment in children using combination therapy, including giardicidal drugs and probiotics, is more effective than monotherapy with giardicidal drugs.

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Marfan Syndrome

Methods of Information in Medicine ◽

10.1055/s-0038-1633999 ◽

2005 ◽

Vol 44 (04) ◽

pp. 487-497 ◽

Cited By ~ 5

Author(s):

G. Mátyás ◽

B. Steinmann ◽

D. Baumgartner ◽

C. Baumgartner

Keyword(s):

Medical Treatment ◽

Marfan Syndrome ◽

Clinical Symptoms ◽

Early Stage ◽

Molecular Genetic ◽

Clinical Manifestations ◽

Hierarchical Cluster ◽

Molecular Genetic Analysis ◽

Missense Mutations ◽

Surgical Interventions

Summary Objectives: Marfan syndrome (MFS) is an autosomal dominant inherited connective tissue disorder caused by mutations in the fibrillin-1 (FBN1) gene with variable clinical manifestations in the cardiovascular, musculoskeletal and ocular systems. Methods: Data of molecular genetic analysis and a catalogue of clinical manifestations including aortic elastic parameters were mined in order to (i) assess aortic abnormality before and during medical treatment, and to (ii) identify novel correlations between the genotype and phenotype of the disease using hierarchical cluster analysis and logistic regression analysis. A score measure describing the similarity between a patient’s clinical symptoms and a characteristic phenotype class was introduced. Results: A probabilistic model for monitoring the loss of aortic elasticity was built on merely aortic parameters of 34 patients with classic MFS and 43 control subjects showing a sensitivity of 82% and a specificity of 96%. The clinical phenotypes of 100 individuals with classical or suspected MFS were clustered yielding four different phenotypic expressions. The highest correlation was found between FBN1 missense mutations, which manifested as ectopia lentis, skeletal major and skin minor criteria, and two out of four clustered phenotypes. The probability of the presence of a missense mutation in both phenotype classes is approximately 70%. Conclusions: Monitoring of aortic elastic properties during medical treatment may serve as additional criterion to indicate elective surgical interventions. Genotype-phenotype correlation may contribute to anticipate the clinical consequences of specific FBN1 mutations more comprehensively and may be helpful to identify MFS patients at risk at an early stage of disease.

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SALMONELLA SPONDYLITIS IN NON-SICKLE CELL PATIENTS

Journal of Musculoskeletal Research ◽

10.1142/s0218957701000593 ◽

2001 ◽

Vol 05 (04) ◽

pp. 253-260

Author(s):

PO-QUANG CHEN ◽

SHU-HUA YANG ◽

CHANG-CHOU YEN ◽

WEN-JER CHEN ◽

TIFFANY T. F. SHIH

Keyword(s):

Antibiotic Treatment ◽

Sickle Cell ◽

Clinical Symptoms ◽

Laboratory Data ◽

Clinical Manifestations ◽

Positive Culture ◽

Surgical Debridement ◽

Treatment Modalities ◽

Endemic Region ◽

Treatment Comparison

This article was a retrospective study of Salmonella spondylitis in seven non-sickle cell anemic patients. The objective of this study was to clarify the clinical manifestations of spinal infection by Salmonella, and to select the proper method of treatment. Comparison with the reported 25 cases in the literature was also attempted. The clinical symptoms and signs, laboratory data, bony images, treatment modalities and outcomes were documented, and compared with the 25 cases in the English literatures. The patients all suffered from insidious onset of low back pain, with progressive increasing intensity. Leucocytosis (>9000) and body temperature elevation (>37°C) were noted in four cases. Positive cultures were mainly obtained from blood (5 cases) and surgical specimens (one case) before treatment. One patient also had positive culture in the stool and urine. Six patients underwent surgical debridement of the infected foci, while one patient received antibiotic treatment only. The outcome was good in the uncomplicated cases. One patient with concurrent aortic aneurysm died of sepsis. We stress that Salmonella infection can be found in the apparently healthy persons. In the endemic region, high suspicion is needed. Surgical debridement, bone grafting and two months of antibiotic treatment are recommended.

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Comparative analysis of chronic rhinitis patient profiles during autumn pollen season between grassland and non-grassland cities in North China

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-021-00591-w ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Xu Xu ◽

Long Qin ◽

Lei Ren ◽

Chengshuo Wang ◽

Yuan Zhang ◽

...

Keyword(s):

Allergic Rhinitis ◽

Pollen Season ◽

Clinical Symptoms ◽

Common Factors ◽

Treatment Modalities ◽

Considerable Proportion ◽

Factors Affecting ◽

Chronic Rhinitis ◽

Number Of Patients ◽

The Impact

Abstract Background The symptoms of patients with respiratory disease are influenced by local environmental factors. The incidence of allergic rhinitis in grassland areas was significantly higher than that in non-grassland areas. We aimed to compare the profiles of chronic rhinitis patients obtained during the autumn pollen season in Baotou (grassland city) and Beijing (non-grassland city), China. Methods Questionnaire surveys and allergen testing were conducted on 1170 and 1232 patients with chronic rhinitis visiting the Second Affiliated Hospital of Baotou Medical College and Beijing Tongren Hospital, respectively, during the autumn pollen period. Information regarding medical history, severity of symptoms, and diagnosis and treatment was collected. Results More patients with moderate to severe chronic rhinitis and asthma (both, P < 0.001) were present in Baotou than in Beijing. Mugwort was the most abundant allergen in both regions, but the number of patients sensitized to outdoor allergens in Baotou was higher than that in Beijing (P < 0.001). Indoor allergens in Beijing represented a considerable proportion of allergens, especially dust mites (33.4%). For patients with allergic rhinitis, nasal congestion, nasal itching, and runny nose were more severe in Baotou than in Beijing (P < 0.001). In both Baotou and Beijing, allergy (P < 0.001 vs. P = 0.004) and combined asthma (P = 0.049 vs. P = 0.005) were common factors affecting the severity of the clinical symptoms chronic rhinitis. In Baotou, age (rs = 0.195, P < 0.001) and family allergy history (P = 0.010) were also associated with symptom severity. Although significantly more patients in Baotou received oral antihistamines, nasal corticosteroids, and surgical treatment than in Beijing (P < 0.001), the number of people receiving allergy immunotherapy in Baotou was lower (P = 0.004) and post-treatment symptom control was worse (P < 0.001) that that in Beijing. Conclusions During the pollen period, there were significant differences in the allergen spectrum between Baotou and Beijing. Allergy and combined asthma were common factors affecting the severity of clinical symptoms. Patients in Baotou presented with more severe clinical symptoms that were not satisfactorily managed due to the impact of pollen exposure, inconsistent access to care, and differing treatment modalities.

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MON-313 Thyrotropin-Secreting Pituitary Tumors: Clinical Features, Diagnostic Criteria and Treatment Outcomes in 28 Patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1653 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Diana A Dimitrova ◽

Evgeniy T Abdullin ◽

Elena G Przhiyalkovskaya ◽

Andrey Yu. Grigoriev ◽

Vilen N Azizyan ◽

...

Keyword(s):

Pituitary Adenoma ◽

Thyroid Hormones ◽

Medical Treatment ◽

Combined Treatment ◽

Laboratory Data ◽

Clinical Manifestations ◽

Case Series ◽

Pituitary Tumors ◽

Mean Value ◽

Somatostatin Analogue

Abstract Introduction Thyrotropin-secreting pituitary adenoma (TSH-oma) is a rare cause of thyrotoxicosis and represents 0.5-3% of all pituitary adenomas. Given the rarity of the disease and the lack of extensive clinical experience in world practice, the analysis of each case of TSH-secreting pituitary tumors is extremely relevant. Materials and methods: We enrolled consecutive patients with TSH secreting pituitary adenoma. TSH (0,25-3,5 mIU/L), FT4 (9-20 pmol/l) FT3 (2,5-5,5 pmol/l) were measured by Architect i2000SR (Abbott Laboratories, Abbott Park, Illinois, U.S.A). An octreotide test consisted of injecting short-acting somatostatin analogue (SSA) at a dose of 100 μg 3 times a day subcutaneously during 3 days or long-acting SSA 20 mg in 28 days minimum for two months and measuring thyroid profile blood tests before and at the end of the test. MRI was performed on GE Optima MR450w 1.5T. Results: We present 28 case series with TSH-omas followed in our center from 2010 to 2019, the median age - 46 (from 10 to 71 years) with a predominance of a female (21 cases) over a male (7 cases). Clinical manifestations included cardiac arrhythmias (82.1%), neurological changes (60.7%), visual impairment (39.3%), osteoporosis (28.6%), hypopituitarism (7.1%). At first admission, 17 patients had increased TSH, FT3 and FT4; in 7 patients - FT3 and FT4 only, and in 4 - an increase was in one of the hormones; mean value of TSH was 5,04 mIU/L, FT4 - 24,46 pmol/l, FT3 - 8,9 pmol/l. SSBG, CTx, osteocalcin were elevated in 60.9%, 57.9% and 31.6% of cases, respectively. In 88.5% of cases octreotide test led to thyroid hormones normalization. On MRI macroadenomas was registered in 67.9%. In 12 patients, diagnosis was confirmed by immunohistochemical examination. In 12 patients, the diagnosis verification was based on remission after surgical and medical treatment. In the remaining four cases, the diagnosis was made on clinical and laboratory data, however, confirmation was inconceivable due to inefficacy of medical treatment. Remission was achieved in 23 patients: 17 of 21 after neurosurgery (81%), 3 of 7 after primary administration of SSA, and 3 after administration of SSA after surgery (100% remission in cases of combined treatment and 42.9% of monotherapy); 3 out of 5 patients who did not achieve remission were lost for observation. Two patients died: in one case due to the brain herniation and cachexia in active thyrotoxicosis. In second case, the patient developed a mental disorder (catatonia) after the second transphenoidal adenomectomy, which led to death. Conclusion The diagnosis of TSH-oma should be based on all thyroid hormones assessment, since biochemical thyrotoxicosis can manifest itself in various ways. The most effective treatment is transphenoidal adenomectomy. If a neurosurgery is not effective or contraindicative, preoperative preparations SSA can be used.

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Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis—Review of the Literature

Medicina ◽

10.3390/medicina56050225 ◽

2020 ◽

Vol 56 (5) ◽

pp. 225

Author(s):

Marcin Derwich ◽

Maria Mitus-Kenig ◽

Elzbieta Pawlowska

Keyword(s):

Temporomandibular Joint ◽

Dental Treatment ◽

Clinical Symptoms ◽

Interdisciplinary Approach ◽

Degenerative Joint Disease ◽

Joint Disease ◽

Treatment Modalities ◽

Age Related ◽

Number Of Patients ◽

Temporomandibular Joint Osteoarthritis

Background and objectives: There is an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.

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Newborn Screening for Cystic Fibrosis in Russia: A Catalyst for Improved Care

International Journal of Neonatal Screening ◽

10.3390/ijns6020034 ◽

2020 ◽

Vol 6 (2) ◽

pp. 34

Author(s):

Victoria Sherman ◽

Elena Kondratyeva ◽

Nataliya Kashirskaya ◽

Anna Voronkova ◽

Victoria Nikonova ◽

...

Keyword(s):

Cystic Fibrosis ◽

Newborn Screening ◽

Pulmonary Infection ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Group I ◽

Time Period ◽

Number Of Patients ◽

Pseudomonas Aeruginosa Infection ◽

Diagnosis Age

In order to assess the effectiveness of the detection of cystic fibrosis (CF) patients by screening compared with diagnoses based on clinical manifestations, the data of the National CF Patient Registry (NCFPR) from the year 2012 (group I: children aged 6–9 years, diagnosed prior to the start of screening) were compared with the data in the NCFPR from the year 2015 (group II: children 6–9 years after the start of screening) for CF patients from the Moscow region. Homozygotes for c.1521_1523delCTT (F508del) were separately compared in both groups. The average diagnosis age, genotype, body mass index, spirometry data, pulmonary infection, medications, and presence of complications were analyzed. This study demonstrated that in the c.1521_1523delCTT (F508del) homozygote group, the patients diagnosed by screening had significant advantages over the patients born before the start of newborn screening in the diagnosis age, the number of patients with chronic Pseudomonas aeruginosa infection, the pulmonary function, and the growth in the percentiles. Newborn screening (NBS) detects nearly twice as many CF patients as the diagnostics based on clinical symptoms during the same time period. Importantly, patients will benefit from the early diagnosis of the disease and the early start of therapy.

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Clinical and laboratory findings of patients with the possible diagnosis of influenza hospitalized in affiliated hospitals of Babol University of Medical Sciences, 2015-2016

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2018-0022 ◽

2018 ◽

Vol 31 (3) ◽

pp. 113-116 ◽

Cited By ~ 1

Author(s):

Mostafa Javanian ◽

Arefeh Babazadeh ◽

Soheil Ebrahimpour ◽

Mehran Shokri ◽

Masomeh Bayani

Keyword(s):

Clinical Laboratory ◽

Clinical Symptoms ◽

Clinical Signs ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Medical Sciences ◽

Laboratory Findings ◽

Cross Sectional ◽

Number Of Patients ◽

Epidemiological Characteristics

Abstract The clinical and para clinical manifestations of influenza in various patients have range from an autoimmune disease to a life-threatening respiratory infection. In addition, the severity of the disease is influenced by factors such as demographic factors, underlying diseases, and immune response. Therefore, in this study, we evaluated the clinical, laboratory and epidemiological characteristics of patients with this type of influenza in Babol (north of Iran). This study was conducted as a descriptive cross-sectional study from October 2015 to March 2016. Subsequently, in this study, records of 123 patients with clinical signs of the influenza-like disease who have undergone the clinical sign in hospitals affiliated to Babol University of Medical Sciences were reviewed. Of 123 patients admitted to a possible diagnosis of influenza, 58 patients (47.2%) were PCR positive for H1N1, while seventy nine (64.2%) participants were women and 21 (17.1%) had diabetes or underlying lung disease. Most of the involved age groups were of individuals above the age of 50. These were followed by the 21-35 years-old. Fever (78%), cough (65.9%), shivering (58.5%) and myalgia (56.1%) were the most common clinical symptoms. Increased levels of transaminases (43.1%), leukocytosis (35.8%) and thrombocytopenia (34.2%) were as well reported in patients as the most frequently reported para clinical findings. In the present study, the most usual clinical symptoms were fever, cough, chill, and myalgia, while gastrointestinal symptoms were also noticeably observed in patients. In an experimental study, a significant number of patients showed leukocytosis and thrombocytopenia and increased transaminases.

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PATHOGENETIC ROLE OF NITROGEN MONOXIDE EFFICIENCY OF PHARMACOTHERAPY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE AND STABLE ANGINA OF TENSION

Wiadomości Lekarskie ◽

10.36740/wlek201905105 ◽

2019 ◽

Vol 72 (5) ◽

pp. 753-756

Author(s):

Oksana S. Khukhlina ◽

Viktoriia Yu. Drozd ◽

Alona A. Antoniv ◽

Tamara H. Kopchuk ◽

Zoriana Ia. Kotsiubiichuk

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Stable Angina ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Nitrogen Monoxide ◽

Basic Therapy ◽

Long Acting

Introduction: The search for new mechanisms of their interconnection and effective pharmacological correction of gastroesophageal reflux disease (GERD) for comorbidity with stable angina of tension (SAT). The aim: To establish the role of nitrogen monoxide (NO) in the pathogenesis of GERD in patients with SAT and to study the effectiveness of the correction of the basic therapy of SAT in order to eliminate the clinical manifestations of GERD and prevent its development. Materials and methods: 88 patients with SAT with a comorbid GERD were examined. We determined clinical symptoms, the level of stable NO metabolites, calculated the number of nitroglycerin tablets taken one week. All patients (2 groups) received baseline therapy for GERD and SAT. In this case, the patients of the 2nd group (45 persons) received therapy with the exception of long-acting nitrates and, in addition, meldonium for 30 days. Results: With the exception of the use of nitro-containing drugs and adding to the basic therapy of SAT the drug meldonium we faster (p<0,05) achieved a regression of clinical symptoms of GERD and decrease in the level of metabolites NO molecule in patients with SAT. Conclusion: In the case of the exclusion of the intake of long-acting nitrates with the adding of meldonium to the basal therapy of the SAT and the GERD the content of metabolites of nitrogen monoxide in the blood is more normalized, which correlates with a decrease in the frequency of GERD symptoms in patients with SAT and GERD.

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