Oesophageal Laboratory, Guys and St Thomas' NHS Foundation Trust, London, UK.
Aliment Pharmacol Ther. 2013 Mar;37(5):555-63. doi: 10.1111/apt.12208. Epub 2013 Jan 10.
Obese patients have an increased risk of gastro-oesophageal reflux disease; however, the mechanism underlying this association is uncertain.
To test the hypothesis that mechanical effects of obesity on oesophageal function increase acid exposure and symptoms.
Height, weight and waist circumference (WC) were measured in patients with typical reflux symptoms referred for manometry and 24 h ambulatory pH studies. Symptom severity was assessed by questionnaire. The association between obesity [WC, body mass index (BMI)], oesophageal function, acid exposure and reflux symptoms was assessed.
Physiological measurements were obtained from 582 patients (median age 48, 56% female) of whom 406 (70%) completed symptom questionnaires. The prevalence of general obesity was greater in women (BMI ≥ 30 kg/m(2) ; F 23%:M 16%; P = 0.056), however more men had abdominal obesity (WC ≥ 99 cm (M 41%:F 28%; P = 0.001)). Oesophageal acid exposure increased with obesity (WC: R = 0.284, P < 0.001) and was associated also with lower oesophageal sphincter (LOS) pressure, reduced abdominal LOS length and peristaltic dysfunction (all P < 0.001). Univariable regression showed a negative association of WC with both LOS pressure and abdominal LOS length (R = -0.221 and -0.209 respectively; both P < 0.001). However, multivariable analysis demonstrated that the effects of increasing WC on oesophageal function do not explain increased acid reflux in obese patients. Instead, independent effects of obesity and oesophageal dysfunction on acid exposure were present. Reflux symptoms increased with acid exposure (R = 0.300; P < 0.001) and this association explained increased symptom severity in obese patients.
Abdominal obesity (waist circumference) is associated with oesophageal dysfunction, increased acid exposure and reflux symptoms; however, this analysis does not support the mechanical hypothesis that the effects of obesity on oesophageal function are the cause of increased acid exposure in obese patients.
肥胖患者患胃食管反流病的风险增加；然而，这种关联的机制尚不确定。
检验肥胖对食管功能的机械影响是否会增加酸暴露和症状的假设。
对因动力测压和 24 小时动态 pH 研究而转诊的有典型反流症状的患者进行身高、体重和腰围（WC）测量。通过问卷调查评估症状严重程度。评估肥胖[WC、体重指数（BMI）]、食管功能、酸暴露和反流症状之间的关联。
从 582 名患者（中位年龄 48 岁，56%为女性）中获得生理测量值，其中 406 名（70%）完成了症状问卷。女性中普遍肥胖的患病率更高（BMI≥30kg/m2；F23%：M16%；P=0.056），而男性中腹型肥胖的患病率更高（WC≥99cm；M41%：F28%；P=0.001）。食管酸暴露随肥胖而增加（WC：R=0.284，P<0.001），并与较低的食管下括约肌（LOS）压力、减少的腹部 LOS 长度和蠕动功能障碍相关（均 P<0.001）。单变量回归显示 WC 与 LOS 压力和腹部 LOS 长度呈负相关（R=-0.221 和-0.209，均 P<0.001）。然而，多变量分析表明，WC 对食管功能的影响并不能解释肥胖患者酸反流增加的原因。相反，肥胖和食管功能障碍对酸暴露的独立影响存在。反流症状随酸暴露而增加（R=0.300；P<0.001），这一关联解释了肥胖患者症状严重程度的增加。
腹型肥胖（腰围）与食管功能障碍、酸暴露增加和反流症状相关；然而，该分析并不支持肥胖对食管功能的机械影响是肥胖患者酸暴露增加的原因的假设。
