Trovato Alexa, Tsang Tyler, Manem Nihita, Donovan Katherine, Gemoets Darren E, Ashley Christopher, Dellon Evan S, Tadros Micheal
Albany Medical College, 43 New Scotland Avenue, Albany, NY, 12208, USA.
Albany Stratton VA Medical Center, 113 Holland Ave, Albany, NY, 12208, USA.
Dysphagia. 2023 Jun;38(3):866-873. doi: 10.1007/s00455-022-10510-9. Epub 2022 Sep 8.
Whether obesity is protective against progression of EoE is unknown. The aim of this study was to assess factors that alter the progression of EoE and determine if BMI is correlated with reduced disease severity. In this retrospective analysis of the Department of Veterans Affairs electronic health records, patients with EoE who received at least one dilation were identified using ICD and CPT codes. Kaplan-Meier curves determined the relationship between BMI and time to second esophageal dilation as a measurement of severity of disease. Cox proportional hazards models assessed the risk of second dilation adjusted for potential confounders. Of 2890 patients with EoE and at least one dilation, 40% were obese (n = 1165). There were no clinically significant differences in demographics between obese and non-obese patients. Non-obese patients were more likely to be smokers and had a higher mean average of the number of dilation visits compared to obese patients (p < 0.05). When stratified by obesity, non-obese individuals had a median time to next dilation of 6.53 years (95% CI (5.83, 7.79)) compared to 9.24 years for obese individuals (95% CI (7.40, 15.04)). When stratified by six BMI categories, median time to second dilation increased with increasing BMI. The hazard ratio of second dilation for obese individuals was 0.81 (95% CI (0.72-0.92)). EoE patients with a higher BMI were less likely to undergo a second dilation compared to those with a lower BMI. Obesity may have a protective role in EoE or severe strictures may lead to malnourishment. Further research into these possibilities is needed.
肥胖是否对嗜酸性食管炎（EoE）的进展具有保护作用尚不清楚。本研究的目的是评估影响EoE进展的因素，并确定体重指数（BMI）是否与疾病严重程度降低相关。在这项对退伍军人事务部电子健康记录的回顾性分析中，使用国际疾病分类（ICD）和现行程序编码（CPT）识别接受过至少一次扩张治疗的EoE患者。Kaplan-Meier曲线确定了BMI与第二次食管扩张时间之间的关系，以此作为疾病严重程度的衡量指标。Cox比例风险模型评估了在调整潜在混杂因素后第二次扩张的风险。在2890例患有EoE且至少接受过一次扩张治疗的患者中，40%为肥胖患者（n = 1165）。肥胖患者和非肥胖患者在人口统计学特征上没有临床显著差异。与肥胖患者相比，非肥胖患者更可能是吸烟者，且扩张就诊次数的平均均值更高（p < 0.05）。按肥胖分层时，非肥胖个体下次扩张的中位时间为6.53年（95%置信区间（5.83, 7.79）），而肥胖个体为9.24年（95%置信区间（7.40, 15.04））。按六个BMI类别分层时，第二次扩张的中位时间随BMI升高而增加。肥胖个体第二次扩张的风险比为0.81（95%置信区间（0.72 - 0.92））。与BMI较低的EoE患者相比，BMI较高的患者接受第二次扩张的可能性较小。肥胖可能对EoE具有保护作用，或者严重狭窄可能导致营养不良。需要对这些可能性进行进一步研究。
