Ribeiro Marcelo, Forcelini Cassiano Mateus, Jr José Carlos Tomiozzo, Soder Ricardo Bernardi, Fornari Fernando
Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre-RS (Marcelo Ribeiro, José Carlos Tomiozzo Jr., Fernando Fornari).
Clínica KOZMA, Passo Fundo-RS (Marcelo Ribeiro).
Ann Gastroenterol. 2023 Sep-Oct;36(5):504-510. doi: 10.20524/aog.2023.0818. Epub 2023 Jul 3.
Gastroesophageal reflux disease (GERD) has a complex pathophysiology and a heterogeneous symptom profile. The brain-esophageal axis in GERD has been studied with functional brain imaging during the last decades, but data from obese patients was just recently reported. A comparison of such a group with non-obese subjects is lacking in the literature. This study aimed to evaluate heartburn perception and brain connectivity responses during esophageal acid stimulation in subjects with and without obesity, controlling for the presence of typical reflux symptoms.
In this cross-sectional study, 25 patients with obesity (body mass index ≥30 kg/m) and 46 subjects without obesity underwent functional magnetic resonance imaging (fMRI) of the brain with esophageal water and acid perfusion. The fMRI paradigm and connectivity were assessed.
About two-thirds of the participants had reflux symptoms. Heartburn perception during fMRI did not differ between subjects with and without obesity. The presence of reflux symptoms was associated with lower activation in frontal brain regions during acid perfusion compared to water perfusion. Compared to subjects without obesity, patients with obesity presented significantly lower connectivity within the anterior salience network. Corrected clusters included left caudate, left putamen and left anterior cingulate gyrus.
The brain-esophagus axis showed differences between subjects with and without obesity. Even without symptomatic differences following esophageal acid perfusion, patients with reflux symptoms showed less brain activation in frontal areas, while obese individuals presented lower connectivity within the anterior salience network.
胃食管反流病（GERD）具有复杂的病理生理学和异质性症状表现。在过去几十年中，人们通过功能性脑成像对GERD中的脑-食管轴进行了研究，但肥胖患者的数据直到最近才被报道。文献中缺乏此类人群与非肥胖受试者的比较。本研究旨在评估有肥胖和无肥胖受试者在食管酸刺激期间的烧心感知和脑连接反应，并控制典型反流症状的存在。
在这项横断面研究中，25名肥胖患者（体重指数≥30kg/m²）和46名非肥胖受试者接受了食管注水和注酸时的脑功能磁共振成像（fMRI）检查。对fMRI范式和连接性进行了评估。
约三分之二的参与者有反流症状。fMRI期间，有肥胖和无肥胖受试者的烧心感知无差异。与注水相比，灌注酸时反流症状的存在与额叶脑区较低的激活有关。与非肥胖受试者相比，肥胖患者在前显著性网络内的连接性显著较低。校正后的簇包括左侧尾状核、左侧壳核和左侧前扣带回。
脑-食管轴在有肥胖和无肥胖受试者之间存在差异。即使食管酸灌注后没有症状差异，有反流症状的患者额叶脑区的激活也较少，而肥胖个体在前显著性网络内的连接性较低。
