Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan.
Aliment Pharmacol Ther. 2011 Oct;34(8):994-1004. doi: 10.1111/j.1365-2036.2011.04817.x. Epub 2011 Aug 17.
The diagnosis of gastro-oesophageal reflux disease (GERD) is based on reflux symptoms. Although metabolic syndrome has been linked to erosive oesophagitis (EO), the impact of insulin resistance, the core of the metabolic syndrome, on reflux symptoms remains to be elucidated.
To assess the effects of insulin resistance on GERD, including both endoscopic findings and symptoms.
A total of 743 sonographic noncirrhotic adult subjects, who underwent an upper gastrointestinal endoscopic examination, completed a gastro-oesophageal reflux questionnaire and had available fasting insulin data were included. Endoscopic findings were classified according to the Los Angeles classification. Homeostatic model assessment-insulin resistance (HOMA-IR) index was used to evaluate the status of insulin resistance. Univariate and multivariate approaches were used to evaluate the associations between insulin resistance and GERD.
Older age, male gender, smoking and alcohol consumption increased the prevalence of EO, but not GERD symptoms. A large waist circumference, high fasting blood glucose levels and high number of metabolic syndrome components were associated with increased prevalence of both EO and GERD symptoms, while high blood pressure was associated with increased prevalence of EO only. Moreover, higher scores in the gastro-oesophageal reflux questionnaire were associated with higher HOMA-IR index, and higher HOMA-IR index was associated with increased prevalence of EO (adjusted odds ratio 1.14, 95% CI 1.03-1.26, P = 0.012).
Our findings demonstrate clear associations between insulin resistance, metabolic syndrome and GERD. Whether reducing insulin resistance may improve GERD symptoms or EO deserves prospective study.
胃食管反流病（GERD）的诊断基于反流症状。尽管代谢综合征与糜烂性食管炎（EO）有关，但胰岛素抵抗作为代谢综合征的核心，对反流症状的影响仍有待阐明。
评估胰岛素抵抗对 GERD 的影响，包括内镜检查结果和症状。
共纳入 743 例超声非肝硬化成年患者，这些患者接受了上消化道内镜检查，完成了胃食管反流问卷，并提供了空腹胰岛素数据。内镜检查结果按照洛杉矶分类进行分类。稳态模型评估-胰岛素抵抗（HOMA-IR）指数用于评估胰岛素抵抗状态。采用单因素和多因素方法评估胰岛素抵抗与 GERD 之间的关系。
年龄较大、男性、吸烟和饮酒会增加 EO 的患病率，但不会增加 GERD 症状的患病率。大腰围、高空腹血糖水平和高数量的代谢综合征成分与 EO 和 GERD 症状的患病率增加有关，而高血压仅与 EO 的患病率增加有关。此外，胃食管反流问卷的评分较高与 HOMA-IR 指数较高相关，而 HOMA-IR 指数较高与 EO 的患病率增加相关（调整后的优势比 1.14，95%置信区间 1.03-1.26，P = 0.012）。
我们的研究结果表明，胰岛素抵抗、代谢综合征与 GERD 之间存在明确的关联。降低胰岛素抵抗是否可以改善 GERD 症状或 EO 值得进一步的前瞻性研究。
