University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA.
Aliment Pharmacol Ther. 2013 Apr;37(8):810-8. doi: 10.1111/apt.12270. Epub 2013 Mar 4.
Higher body mass index (BMI) is a recognised risk factor for gastro-oesophageal reflux disease (GERD). Data regarding the impact of BMI on proton pump inhibitor (PPI) therapy are conflicting.
To assess the impact of BMI on baseline heartburn symptom severity and frequency and response to PPI therapy in patients with non-erosive GERD (NERD) or erosive oesophagitis (EO).
In post hoc analyses of phase 3 trial data, 621 NERD and 2692 EO patients were stratified by BMI (<25, 25 to <30 and ≥30 kg/m(2) ). NERD patients received either dexlansoprazole MR 30 mg or placebo daily for 4 weeks. EO patients received either dexlansoprazole MR 60 mg or lansoprazole 30 mg for 8 weeks. Symptom frequency and severity were assessed at baseline and subsequently by daily diary.
In both the NERD and EO cohorts, baseline heartburn severity increased with increasing BMI. The impact of PPI therapy on the reduction in heartburn symptom frequency and severity in both NERD and EO patients was similar across BMI categories. EO healing rates in patients treated with dexlansoprazole but not lansoprazole were higher in obese patients compared with those with a BMI <30 kg/m(2) . Differences between the PPIs were small.
The PPIs evaluated in this study reduced the frequency and severity of 24-h heartburn regardless of baseline BMI. In addition, because patients with higher BMI have more severe symptoms at baseline, they may experience greater therapeutic gain with dexlansoprazole (NERD and erosive oesophagitis) and possibly lansoprazole (erosive oesophagitis) treatment.
较高的体重指数（BMI）是胃食管反流病（GERD）的公认危险因素。关于 BMI 对质子泵抑制剂（PPI）治疗影响的数据存在争议。
评估 BMI 对非糜烂性胃食管反流病（NERD）或糜烂性食管炎（EO）患者基线烧心症状严重程度和频率以及对 PPI 治疗反应的影响。
在 3 期试验数据的事后分析中，621 例 NERD 和 2692 例 EO 患者根据 BMI（<25、25 至<30 和≥30 kg/m2）进行分层。NERD 患者每日接受多潘立酮 MR 30mg 或安慰剂治疗 4 周。EO 患者接受多潘立酮 MR 60mg 或兰索拉唑 30mg 治疗 8 周。在基线和随后的每日日记中评估症状频率和严重程度。
在 NERD 和 EO 两组中，基线烧心严重程度随 BMI 增加而增加。在 NERD 和 EO 患者中，PPI 治疗对减少烧心症状频率和严重程度的影响在 BMI 类别之间相似。与 BMI<30kg/m2 的患者相比，接受多潘立酮治疗的肥胖患者的 EO 愈合率更高，但接受兰索拉唑治疗的患者则不然。两种 PPI 之间的差异很小。
本研究评估的 PPI 可降低 24 小时烧心的频率和严重程度，无论基线 BMI 如何。此外，由于基线时 BMI 较高的患者症状更严重，他们可能会从多潘立酮（NERD 和糜烂性食管炎）和可能的兰索拉唑（糜烂性食管炎）治疗中获得更大的治疗收益。
