Saint’s Triad and the dysplasia-dependent phenotype of patients in the context of multimorbidity
Abstract. The factor uniting independent nosologies (hiatal hernia, cholelithiasis, and intestinal diverticulosis) into a consistent multimorbidity – Saint’s triad (ST) – is not obvious, which complicates the development of treatment and preventive measures that minimize the risk of complications and the need for repeated surgical interventions. The aim: to evaluate the totality of clinical manifestations and possible combinations of components of ST in terms of multimorbidity in patients with a dysplasia-dependent phenotype. Material and methods. In a clinical cohort of 77 patients with at least two components of ST, as determined by gastrointestinal imaging, the clinical manifestations, phenotypic, and visceral stigmas of connective tissue dysplasia (CTD) were studied using a diagnostic screening set of its features. The comparison group (70 patients) consisted of patients with hiatal hernia (HH) in whom other components of ST were excluded. Results. Complete ST was detected in 6.5% of cases; in the remaining cases, its components in various combinations formed comorbid pairs. Clinical manifestations at the time of presentation were determined by reflux syndrome in half of the cases, biliary dysfunction in a third, and intestinal disorders in a fifth of the cases. Among the phenotypic signs of CTD, the most prevalent were cutaneous, musculoskeletal, osteoarticular, and cranial; among visceral manifestations – HH, gallbladder anomalies, and colonic diverticula. Quantitative indices established a statistically significant predominance of the number and severity of CTD signs in patients with ST compared to patients with HH (p <0.001), corresponding to the level of moderate CTD. Conclusion. Diagnosis of ST requires an active diagnostic search for its components using instrumental verification of the digestive system. CTD is a structural predictor of ST; identification of a dysplasia-dependent phenotype may prompt an active diagnostic evaluation of the components of multimorbidity.G.S. Dzhulay, A.D. Ivanova, T.E. Dzhulay, I.A. Zyabreva
Keywords
Saint’s triad
hiatal hernia
cholelithiasis
intestinal diverticulosis
connective tissue dysplasia
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About the Authors
Galina S. Dzhulay, MD, Dr. Sci (Medicine), professor, head of the Department of faculty therapy, Tver State Medical University, Tver, Russian Federation.Е-mail: djoulai@mail.ru
ORCID: https://orcid.org/0000-0002-7687-8157. eLibrary SPIN: 4220-7478
Anastasia D. Ivanova, MD, assistant at the Department of faculty therapy, Tver State Medical University, Tver, Russian Federation.
Е-mail: ms.AD19@yandex.ru
ORCID: https://orcid.org/0009-0003-3041-9144. eLibrary SPIN: 5950-0970
Tatiana E. Dzhulay, MD, PhD (Medicine), associate professor, associate professor of the Department of faculty therapy, Tver State Medical University, Tver, Russian Federation.
Е-mail: tdzhulay@mail.ru
ORCID: https://orcid.org/0000-0001-7926-6749. eLibrary SPIN: 5540-8528
Irina A. Zyabreva, MD, PhD (Medicine), associate professor of the Department of faculty therapy, Tver State Medical University, Tver, Russian Federation.
Е-mail: izyabreva14@mail.ru
ORCID: https://orcid.org/0000-0001-9421-9553. eLibrary SPIN: 5701-0032
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