肥胖患者食管症状负担增加源于酸暴露增加而非动力异常。
Higher Esophageal Symptom Burden in Obese Subjects Results From Increased Esophageal Acid Exposure and Not From Dysmotility.
机构信息
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.
Duke University School of Medicine and the Durham VA Medical Center, Durham, North Carolina.
出版信息
Clin Gastroenterol Hepatol. 2020 Jul;18(8):1719-1726. doi: 10.1016/j.cgh.2019.08.019. Epub 2019 Aug 20.
BACKGROUND & AIMS: Esophageal motor disorders (EMD) and pathologic reflux are often identified in obese individuals, but it is not clear how obesity contributes to these symptoms. We examined the relationships among symptom burden, EMD, acid exposure time (AET), symptom association probability, and body mass index (BMI).
METHODS
We performed a retrospective study of 1089 consecutive patients who underwent high-resolution manometry, of which 426 patients also underwent reflux monitoring off acid suppression, over a 2-year period at a tertiary referral center. Symptom burden was assessed by questionnaires to determine dominant symptom intensity (DSI; product of symptom severity, and frequency, on 5-point Likert scales) and global symptom severity (GSS; global esophageal symptoms on 10-cm visual analog scales) at the time of esophageal testing; BMIs were recorded. We compared proportions of patients with EMD and abnormal reflux burden among BMI categories and correlated them with symptom burden.
RESULTS
Four-hundred thirty-three patients (39.8%) met the criteria for EMD. Esophageal outflow obstruction was observed in higher proportions of patients with low BMIs (underweight, 25.9%; normal, 14.1%; overweight, 13.9%; and obese, 9.8%; P = .037), but EMDs were less frequent in obese patients (P = .047), despite higher symptom burden compared with non-obese patients (DSI, 10.5 ± 0.3 vs 9.7 ± 0.2; P = .03 and GSS, 6.5 ± 1 vs 5.9 ± 1; P = .01). Among the 426 patients who underwent reflux monitoring, the proportions with total AET (P = .02), and upright AET (P < .001) increased among BMI categories, supine AET trended strongly (P = .06), in combination with increasing DSI and GSS (P ≤ .001 for each comparison). BMI correlated with symptom burden, higher AET, and positive symptom association probability (P < .01 for each analysis).
CONCLUSIONS
Increased symptom burden in obese individuals correlates with esophageal acid burden but not with motor disorders.
背景与目的
食管运动障碍（EMD）和病理性反流在肥胖个体中经常被发现，但肥胖如何导致这些症状尚不清楚。我们检查了症状负担、EMD、酸暴露时间（AET）、症状关联概率和体重指数（BMI）之间的关系。
方法
我们对在一家三级转诊中心进行了为期 2 年的高分辨率测压检查的 1089 例连续患者进行了回顾性研究，其中 426 例患者还在酸抑制后接受了反流监测。通过问卷评估症状负担，以确定主导症状强度（DSI；5 点 Likert 量表上的症状严重程度和频率的乘积）和全球症状严重程度（10cm 视觉模拟量表上的全球食管症状）；记录 BMI。我们比较了不同 BMI 类别中 EMD 和异常反流负担患者的比例，并将其与症状负担相关联。
结果
433 例（39.8%）患者符合 EMD 标准。食管流出梗阻在 BMI 较低的患者中比例较高（体重不足，25.9%；正常，14.1%；超重，13.9%；肥胖，9.8%；P=0.037），但肥胖患者的 EMD 频率较低（P=0.047），尽管与非肥胖患者相比，他们的症状负担更高（DSI，10.5±0.3 与 9.7±0.2；P=0.03 和 GSS，6.5±1 与 5.9±1；P=0.01）。在 426 例接受反流监测的患者中，总 AET（P=0.02）和直立 AET（P<.001）的比例随 BMI 类别增加而增加，仰卧 AET 呈强烈趋势（P=0.06），同时 DSI 和 GSS 也增加（P≤0.01 用于每项比较）。BMI 与症状负担、更高的 AET 和阳性症状关联概率相关（每项分析 P<.01）。
结论
肥胖个体的症状负担增加与食管酸负担相关，但与运动障碍无关。
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