scholarly journals The results of daily monitoring of salivary pepsin levels in young children with regurgitation syndrome

2021 ◽  
pp. 19-24
Author(s):  
S.I. Ilchenko ◽  
◽  
T.V. Mozheiko ◽  
А.О. Fialkovska ◽  
N.V. Mishina ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Young Children ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Clinical Manifestations ◽  
Main Group ◽  
Diagnostic Methods ◽  
Enzyme Linked Immunosorbent Assay ◽  
Healthy Children ◽  
Daily Monitoring

Regurgitation syndrome in infants is one of the manifestations of gastroesophageal reflux disease (GER), which can be both an age-related physiological condition and pathological one with the risk of gastroesophageal reflux disease (GERD) developing. Differential diagnosis of GERD in infants and young children is difficult due to invasiveness and low availability of the recommended diagnostic methods, in particular esophageal pH3metry. Today, the search for new non-invasive and simple, but sensitive and specific, methods for diagnosing GERD in pediatric practice is relevant and promising. Purpose — to determine the dynamic patterns of the salivary pepsin level in young children within the framework of daily monitoring and depending on the clinical manifestations of regurgitation. Materials and methods. 55 children from 3 to 18 months were examined, among them was 38 children with visible regurgitation syndrome and 17 healthy children without clinical manifestations of the regurgitation syndrome. The intensity of regurgitation was assessed using a five-point scale «ESPGHAN». A reflux questionnaire was used for screening diagnostics of pathological GER in children. Salivary pepsin level was determined three times a day by enzyme-linked immunosorbent assay (ELISA pepsin). Statistical processing was performed using «Statistica v.6.1» software package. Results. Regurgitation syndrome was registered in all children of the main group according to their current complaints. The results of reflux questionnaire showed the following data: half of the children (52.6%) had no signs of GER, possible reflux was revealed in 31.6% of children, and probable reflux was revealed in 15.8% of children. The results of daily monitoring of salivary pepsin level in infants showed that it was significantly higher in children with regurgitation than in control group, both in terms of average daily values and intermediate values. It was found that the maximum pepsin activity in children was immediately after regurgitation. There were no significant differences between the three saliva samples and the average daily pepsin index in the children of the main group, which may indicate the presence of latent episodes of reflux during the day. Сhildren with a high risk of GERD according to the reflux questionnaire had significantly higher values of salivary pepsin on an empty stomach and its average daily level, which has sufficient specificity and predictive value according to the ROC analysis results. Conclusions. Determination of salivary pepsin levels in infants can be included in screening noninvasive tests for the GER diagnosis. The use of these tests to predict the risk of extraesophageal damage requires further study. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: regurgitation, GER, GERD, pepsin, children.

scholarly journals Biochemical Manifestations of Gastroesophageal Reflux Disease Progression in Children: A Single Center Case-Control Study

2020 ◽  
Vol 10 (12) ◽  
pp. 4368
Author(s):  
Gabriela Ghiga ◽  
Nicoleta Gimiga ◽  
Daniel Vasile Timofte ◽  
Oana Maria Rosu ◽  
Vladimir Poroch ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Clinical Manifestations ◽  
Endoscopic Examination ◽  
Control Group ◽  
Healthy Children ◽  
High Blood Glucose ◽  
Biochemical Alterations

Gastroesophageal reflux disease (GERD) is a common digestive condition, representing one of the most frequent reasons for medical examination, especially in pediatric gastroenterology departments. GERD could be associated with biochemical alterations representing either its systemic manifestations or markers of complications. The aim of our paper was to evaluate biochemical parameters secondary to GERD in children. Two hundred and sixty-seven children of both genders aged between 1 month and 18 years who displayed suggestive symptoms for this condition were included in the study and were monitored for a period of 5 years. Depending on the range of symptoms and technical possibilities, the following procedures/investigations were performed: esophageal pH monitoring and imagistic or endoscopic examination, besides specific biochemical investigations. The cohort was sub-divided into two groups: one that included 213 children with confirmed GERD who represented the study group and 54 healthy children where GERD had been excluded, the control group. Out of all the investigated children, 39.0% displayed low hemoglobin values, 43.7% displayed low values of erythrocyte indices (MCH), and 68.5% had increased erythrocyte sedimentation rate (ESR) values, while increased eosinophil levels were recorded in 46.9% of the cases. Such parameters were proven to be a biomarker of suspected eosinophilic esophagitis, whereas 32.9% of the cases displayed high blood glucose values that could be correlated with gastroesophageal reflux symptoms. Other measured parameters (such as magnesium, aminotransferases and proteins) remained within the normal limits, without statistically significant differences compared to in the control group. This condition is diagnosed based on invasive investigations, which are often difficult to accept by the patients’ parents. The biochemical modifications correlated to the clinical manifestations can anticipate the progression of the disease, thus limiting the necessity of performing invasive diagnosis tests.

scholarly journals MODERN VIEWS OF GERD IN CHILDREN: PROBLEMS AND PERSPECTIVES

2017 ◽  
Vol 4 (2) ◽  
pp. 65-71
Author(s):  
Oleksandra Slobodianiuk
Keyword(s):  
Risk Factors ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Clinical Evidence ◽  
Diagnostic Methods ◽  
Prediction Algorithm ◽  
Disease Course ◽  
Pediatric Practice ◽  
Non Invasive

Slobodianiuk O.L.In recent years much attention has been paid to the upper digestive tract diseases in children, particularly GERD, as a reason t,hat has an impact on quality of life even in children of school age and thereafter in young adults. Scientists came to a consensus that all examinations which are used in pediatric practice must be maximally available, simple and non-invasive to the extent practical for child’s condition.The question about practicability of performing esophagogastroduodenoscopy for all patients with complaints of heartburn and with other symptoms of GERD, the question relative to performing ultrasonography of the esophagus for children as an additional method of examination, usage of questionnaire in pediatric practice, formation of disease course prediction algorithm, and identification of preventive measures specific to every patient remain open.Therefore the goal of this research is to provide an overview of modern literature with reference to problematic issues of clinical evidence, risk factors, diagnostics, prediction of gastroesophageal reflux disease course in children of different age (regarding main causative and pathogenic factors, clinical evidence (esophageal and extra-esophageal), diagnostic methods and modern approaches to gastroesophageal reflux disease treatment).Key words: gastroesophageal reflux disease, non-invasive diagnostics, risk factors, prediction of disease course. СУЧАСНІ ПОГЛЯДИ НА ГЕРХ У ДІТЕЙ: ПРОБЛЕМИ ТА ПЕРСПЕКТИВИСлободянюк О.Л.Останнім часом багато уваги приділяється захворюванням верхніх відділів травного тракту у дітей, зокрема й ГЕРХ,  як причині, що призводить до порушення якості життя вже у дітей шкільного віку, а в подальшому і у людей молодого віку. Вчені дійшли консенсусу, що всі обстеження, які використовуються в педіатричній практиці повинні бути максимально доступними, простими та неінвазивними, наскільки це дозволяє стан дитини.Залишається відкритим питання про доцільність проведення ФЕГДС всім пацієнтам зі скаргами на печію та іншими симптомами ГЕРХ , питання щодо застосування УЗД стравоходу у дітей як додаткового методу обстеження, використання опитувальників в педіатричній практиці, формування алгоритмів прогнозування перебігу захворювання та визначення профілактичних заходів  індивідуально для кожного пацієнта.Отже, метою цієї роботи було виконати огляд сучасної літератури з проблемних питань клінічних проявів, факторів ризику, діагностики, прогнозування перебігу гастроезофагеальної рефлексної хвороби у дітей різного віку (з питань основних етіологічних та патогенетичних факторів, клінічних проявів (стравохідних та позастравохідних), методів діагностики та сучасних підходів до лікування гастроезофагеальної рефлексної хвороби).Ключові слова: гастроезофагеальна рефелюксна хвороба, неінвазивна діагностика, фактори ризику, прогнозування перебігу.  СОВРЕМЕННЫЕ ВЗГЛЯДЫ НА ГЕРБ У ДЕТЕЙ: ПРОБЛЕМЫ И ПЕРСПЕКТИВЫСлободянюк А.Л.В последнее время больше внимания уделяется заболеванием верхних отделов пищеварительного тракта у детей, в том числе и ГЭРБ, как причине, которая приводит к нарушению качества жизни уже у детей школьного возраста, а в дальнейшем и у людей молодого возраста. Ученые пришли к консенсусу, что все обследования, которые используются в педиатрической практике должны быть максимально доступными, простыми и неинвазивными, насколько это позволяет состояние ребенка. Остается открытым вопрос о целесообразности проведения ФЭГДС всем пациентам с жалобами на изжогу и другими симптомами ГЭРБ, вопросы применения УЗИ пищевода у детей в качестве дополнительного метода обследования, использование опросников в педиатрической практике, формирование алгоритмов прогнозирования течения заболевания и определения профилактических мероприятий индивидуально для каждого пациента.Итак, целью этой работы было выполнить обзор современной литературы по проблемным вопросам клинических проявлений, факторов риска, диагностики, прогнозирования течения гастроэзофагеальной рефлексной болезни у детей разного возраста (по вопросам основных этиологических и патогенетических факторов, клинических проявлений (пищеводных и внепищеводных), методов диагностики и современных подходов к лечению гастроэзофагеальной рефлексной болезни).Ключевые слова: гастроэзофагеальная рефелюксная болезнь, неинвазивная диагностика, факторы риска, прогнозирование течения.

scholarly journals The Diagnostic Significance of Coapplying a Rabeprazole Test with the SF-36 for Gastroesophageal Reflux Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ying Chen ◽  
Feng Wang ◽  
Yuanxi Jiang ◽  
Chen Wang ◽  
Liwen Yao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Low Cost ◽  
Clinical Manifestations ◽  
Life Quality ◽  
Diagnostic Significance ◽  
Sf 36 ◽  
Before And After

Gastroesophageal reflux disease is a diversity disease that affects life quality of people in the world. Due to the complicated pathogenesis and variations in clinical manifestations, there is still no true gold standard for GERD diagnosis, and it is still difficult to diagnose this disease in some patients. The proton pump inhibitor’s diagnostic test (the PPI test) is noninvasive, of low cost, tied to treatment, and widely accepted. Our aim is to evaluate the diagnostic significance of coapplying a rabeprazole test with the SF-36 for GERD in this study. Our study shows that the SF-36 in combination with the rabeprazole test can screen GERD patients and increase the sensitivity and specificity of GERD diagnosis through reference to the change in SF-36 score before and after the treatment (65 in the trial).

scholarly journals Performances of Diagnostic Methods in Gastroesophageal Reflux Disease

2019 ◽  
Vol 16 (1) ◽  
pp. 41-50
Author(s):  
Elena-Roxana Săraru ◽  
Răzvan Peagu ◽  
Ana-Maria Călin-Necula ◽  
Alexandru Moldoveanu ◽  
Carmen Fierbinţeanu-Braticevici
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ambulatory Monitoring ◽  
Diagnostic Methods ◽  
Therapeutic Management ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Dietary Regimen ◽  
Esophageal Ph

AbstractGastroesophageal reflux disease (GERD) is one of the most common chronic gastrointestinal ailments worldwide, with a high prevalence and extremely costly diagnostic and therapeutic management. A hygienic-dietary regimen, accompanied by weight loss, are important factors for improving the symptoms of reflux disease. Various ways of correct diagnosis and for therapeutic management have been attempted over the years, of which themost widely used diagnostic method is empirical therapy with proton pump inhibitors. Also, questionnaires, upper digestive endoscopy with biopsies, barium radiography, ambulatory monitoring of esophageal pH, pH-impedance and esophageal manometry are widely used. Upper gastrointestinal endoscopy has a good specificity, but a low sensitivity for GERD. Also, the GERQ questionnaire has a good sensitivity and specificity in the accuracy of GERD diagnostic. Barium swallow use belongs to the past, and is recommended mostly for the detection of anatomical anomalies and not for the diagnosis of reflux disease. 24-hour ambulatory monitoring of esophageal pH is the study of choice to confirm the diagnosis of reflux disease in patients without endoscopic modifications suggestive of GERD. The association of impedance to esophageal pH monitoring is the gold standard for diagnosing GERD, making it possible to differentiate between acid reflux, weakly acid and non-acid episodes, and is also useful for diagnosing other conditions that mimic the GERD's clinical symptoms.

scholarly journals The role of visceral-abdominal obesity in the development of gastroesophageal reflux disease.

2018 ◽  
Vol 96 (7) ◽  
pp. 658-662
Author(s):  
E. I. Andreeva
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Serum Concentration ◽  
Metabolic Activity ◽  
Interleukin 6 ◽  
Visceral Fat ◽  
Reflux Disease ◽  
Main Group ◽  
C Reactive Protein ◽  
Reactive Protein

Studies of recent years show that the problem of abdominal-visceral obesity is gaining in importance, the steady growth of which is observed in almost all countries. Gastroesophageal reflux disease belongs to the most common diseases in patients with obesity. At present, the question of the metabolic activity of visceral fat as a factor in the pathogenesis of GERD is being investigated. Aim. Investigation of the level of serum concentration of the proinflammatory cytokine (interleukin 6), the biologically active substance -adipokin (leptin) and C-reactive protein, taking into account the BMI of patients with obesity and intra-arterialpH monitoring data and esophagogastroduodenoscopy. Material and methods. The main group consisted of 51 patients, in the age group from 30 to 60 years, suffering from GERD and obesity. The average age of the patients was 42.3 ± 2.11 years. Obesity of the 1st degree in BMI was in 19 people; obesity of the 2nd degree - in 23 people; obesity of the third degree in 9 patients. The level of leptin, interleukin 6 and C-reactive protein was determined, anthropometric examination with calculation of body mass index (BMI) and waist measurement (OT) to determine the degree of obesity and its type. To verify the diagnosis of GERD and determine its endoscopic form, esophagogastroduodenoscopy was performed using flexible endoscopes and intra-esophageal pH monitoring. Results. The level of serum concentration of interleukin 6, leptin and C-reactive protein in patients of the main group is higher than in the control group. A correlation between these indicators, the degree of obesity and the DeMeester index, reflecting the presence and severity of gastroesophageal reflux and the results of esophagogastroduodenoscopy, was revealed. Conclusion. Thus, the metabolic activity of visceral fat is one of the factors contributing to the increase in the duration and the number ofpathological refluxes leading to the development of erosive forms of esophagitis, which must be taken into account when choosing a program for the treatment ofpatients suffering from GERD and obesity.

scholarly journals Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease

2021 ◽  
Vol 5 (6) ◽  
pp. 366-372
Author(s):  
I.V. Matoshina ◽  
◽  
M.A. Livzan ◽  
M.M. Fedorin ◽  
I.V. Lapteva ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Esophagitis ◽  
Reflux Disease ◽  
Comparison Group ◽  
Combined Therapy ◽  
Life Quality ◽  
Main Group ◽  
Esophageal Mucosa

Aim: to evaluate the efficacy and safety of combined therapy with a proton pump inhibitor (PPI) and an esophagoprotector to relieve the symptoms of reflux esophagitis, improve the life quality of patients and achieve faster and complete disease remission. Patients and Methods: a randomized study included 60 patients, including 33 men (mean age 40.96±13.44 years) and 27 women (mean age 48.29±12.69 years) with a duration of gastroesophageal reflux disease (GERD) of 21.85±15.48 months and C/D stage of reflux esophagitis. Depending on the prescribed treatment, the patients were divided into 2 groups of 30 subjects. Patients of the main group received complex therapy: PPI pantoprazole 40 mg once per day and esophagoprotector based on hyaluronic acid, chondroitin sulfate and poloxamer 407. In the comparison group, only pantoprazole was prescribed at the same dosage. The duration of the treatment course in both groups was 4 weeks. Before and after treatment, the presence and severity of complaints were assessed on the Likert scale, life quality according to the SF-36 questionnaire and endoscopic examination data. Results: after the end of the therapy course, a statistically significant decrease in the severity of epigastric burning, regurgitation, substernal pain, gaseous eructation, odynophagia and dysphagia was found both in the main group (in all cases p<0.05, Wilcoxon Matched Pairs Test) and the comparison group (in all cases p<0,05, Wilcoxon Matched Pairs Test). The use of combination therapy made it possible to achieve a more significant improvement in the life quality of patients in all indicators versus PPI monotherapy. In addition, 3 (10%) patients of the main group achieved endoscopic remission, while there were no such patients in the comparison group. The use of esophagoprotector in addition to PPI made it possible to reach the primary and secondary endpoints significantly more commonly versus during monotherapy. Conclusion: the obtained data indicate the high efficiency and safety of PPI therapy in combination with esophagoprotector for relieving the disease symptoms and improving the life quality of patients, faster and complete remission of reflux esophagitis by additional restoration of the esophageal mucosa resistance. Esophagoprotector as a component of complex therapy together with PPI allows achieving clinical and endoscopic disease remission in patients with erosive esophagitis in shorter terms. KEYWORDS: gastroesophageal reflux disease, esophageal mucosa resistance, esophagoprotection, proton pump inhibitor, quality of life. FOR CITATION: Matoshina I.V., Livzan M.A., Fedorin M.M., Lapteva I.V. Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):366–372 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-366-372.

scholarly journals The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Peymaneh Alizadeh Taheri ◽  
Elahe Validad ◽  
Kambiz Eftekhari
Keyword(s):  
Clinical Trial ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Response Rate ◽  
Clinical Manifestations ◽  
Secondary Outcome ◽  
Double Blind ◽  
Term Neonates ◽  
Significant Difference

Background. Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of neonatal GERD are frequent regurgitation or vomiting associated with irritability, crying, anorexia or feeding refusal, failure to thrive, arching of the back, and sleep disturbance. Aims. The efficacy and safety of ranitidine plus metoclopramide and lansoprazole plus metoclopramide in reducing clinical GERD symptoms based on I-GERQ-R scores in neonatal GERD resistant to conservative and monotherapy. Study Design. This study was a randomized clinical trial of term neonates with GERD diagnosis (according to the final version of the I-GERQ-R), resistant to conservative and monotherapy admitted to Bahrami Children Hospital during 2017-2019. Totally, 120 term neonates (mean age 10.91 ± 7.17 days; girls 54.63%) were randomly assigned to a double-blind trial with either oral ranitidine plus metoclopramide (group A) or oral lansoprazole plus metoclopramide (group B). The changes of the symptoms and signs were recorded after one week and one month. At the end, fifty-four neonates in each group completed the study and their data were analyzed. Results. There was no significant difference in demographic and baseline characteristics between the two groups. The response rate of “lansoprazole plus metoclopramide” was significantly higher than “ranitidine plus metoclopramide” ( 7.44 ± 3.86 score vs. 9.3 ± 4.57 score, p = 0.018 ) after one week and ( 2.41 ± 3.06 score vs. 4.5 ± 4.12 score, p = 0.003 ) after one month (primary outcome). There were no drug adverse effects in either group during intervention (secondary outcome). Conclusions. The response rate was significant in each group after one week and one month of treatment, but it was significantly higher in the “lansoprazole plus metoclopramide” group compared with the “ranitidine plus metoclopramide” group. The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention. This study has been registered at the Iranian Registry of Clinical Trails (RCT20160827029535N3).

scholarly journals Neuropsychiatric features of children with systemic somatovegetative disorders (by the example of atopic dermatitis, bronchial asthma and gastroesophageal reflux disease)

2019 ◽  
Vol 10 (3) ◽  
pp. 40-48
Author(s):  
T. S. Petrenko ◽  
K. Yu. Retyunskiy ◽  
M. D. Borovskikh ◽  
D. R. Devyatkina ◽  
A. V. Pereshitova ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Bronchial Asthma ◽  
Reflux Disease ◽  
Energy Functional ◽  
Control Group ◽  
Healthy Children ◽  
Central Nervous System Damage ◽  
Neuropsychological Disorders

Objective: to study the clinical neuropsychiatric and neuropsychological features of children suffering from systemic somatovegetative disorders.Materials and methods: the study involved children from 5 to 12 years old with an established diagnosis of bronchial asthma — 108 children; atopic dermatitis — 105 children; gastroesophageal reflux disease — 112 children; the control group consisted of 60 same age healthy children. All children underwent clinical-anamnestic, neurological, psychopathological and neuropsychological research.Results: the children with systemic somatovegetative disorders have a significantly high incidence of pathogenic factors of central nervous system damage in early stages of ontogenesis (pathology of pregnancy and childbirth). Early sensory and motor deprivation due to somatic suffering aggravates neuropsychiatric deficiency. Neuropsychological disorders were predominantly represented by a violation of the perception of their body, lack of kinesthetic and motor functions, spatial and quasi-spatial representations.Conclusion: the clinical dynamics of neuropsychiatric disorders in children with systemic somatovegetative disorders corresponds to the dynamics of residual cerebral organic impairment with a stage-age changes of syndromes. The revealed neuropsychological disorders correspond to preferential damage to the first (energy) functional block of the brain.

scholarly journals The problem of concomitant diseases with a focus on the cardiovascular system condition in patients with arterial hypertension and acid-related diseases

2013 ◽  
Vol 94 (1) ◽  
pp. 80-85 ◽  
Author(s):  
O V Khlynova ◽  
A V Tuev ◽  
L N Beresneva ◽  
A V Agafonov
Keyword(s):  
Blood Pressure ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Arterial Hypertension ◽  
Reflux Disease ◽  
Medical Science ◽  
Clinical Manifestations ◽  
Pressure Profile ◽  
Arterial Blood ◽  
Blood Pressure Profile

At present, the problem of concomitant diseases still remains very important for medical science as well as for medical practice. Arterial hypertension is one of the most actual global healthcare problems, holding the leading place among cardiovascular diseases. Acid-related diseases, including gastroesophageal reflux disease and duodenal ulcer are also widely-spread with the tendency of prevalence growth, and are having the leading place among gastrointestinal diseases. The combination of arterial hypertension and acid-related diseases is a new state of an organism regulation. Their synchronism is not accidental, as both diseases share links of the general etiology and pathogenesis. The daily arterial pressure profile and heart rhythm variability has a number of distinctive features when the diseases collide. The presence and progression of esophageal and duodenal mucous membranes inflammation in these patients promotes the certain arterial blood pressure profile formation. The data concerning the prevalence, common etiology and pathogenesis, features of hemodynamics and clinical manifestations in patients with arterial hypertension associated with peptic ulcer disease and gastroesophageal reflux disease are reviewed. Data of autonomic regulation features, 24-hour blood pressure profile and central hemodynamics condition in patients the combination with the mentioned diseases are also covered.

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