Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Guangxi Medical University, Nanning, Guangxi, China.
Medicine (Baltimore). 2024 Feb 16;103(7):e37054. doi: 10.1097/MD.0000000000037054.
Traditional observational and in vivo studies have suggested an etiological link between gastroesophageal reflux disease (GERD) and the development of extraesophageal diseases (EEDs), such as noncardiac chest pain. However, evidence demonstrating potential causal relationships is lacking. This study evaluated the potential causal relationship between GERD and EEDs, including throat and chest pain, asthma, bronchitis, chronic rhinitis, nasopharyngitis and pharyngitis, gingivitis and periodontal disease, cough, using multiple Mendelian randomization (MR) methods, and sensitivity analysis was performed. The Mendelian randomization Pleiotropy RESidual Sum and Outlier and PhenoScanner tools were used to further check for heterogeneous results and remove outliers. MR with inverse-variance weighted (IVW) showed a significant causal relationship between GERD and EEDs after Bonferroni correction. IVW results indicated that GERD increased the risk of chronic rhinitis, nasopharyngitis and pharyngitis (odds ratio [OR] = 1.482, 95% confidence interval [CI] = 1.267-1.734, P < .001], gingivitis and periodontal disease (OR = 1.166, 95% CI = 1.046-1.190, P = .001), throat and chest pain (OR = 1.585, 95% CI = 1.455-1.726, P < .001), asthma (OR = 1.539, 95% CI = 1.379-1.717, P < .001), and bronchitis (OR = 1.249, 95% CI = 1.168-1.335, P < .001). Sensitivity analysis did not detect pleiotropy. Leave-one-out analysis shows that MR results were not affected by individual single nucleotide polymorphisms. The funnel plot considers the genetic instrumental variables to be almost symmetrically distributed. This MR supports a causal relationship among GERD and EEDs. Precise moderation based on causality and active promotion of collaboration among multidisciplinary physicians ensure high-quality diagnostic and treatment recommendations and maximize patient benefit.
传统的观察性和体内研究表明,胃食管反流病(GERD)和食管外疾病(EED)之间存在病因联系,例如非心源性胸痛。然而,缺乏证明潜在因果关系的证据。本研究使用多种孟德尔随机化(MR)方法评估 GERD 和 EED 之间的潜在因果关系,包括喉咙和胸痛、哮喘、支气管炎、慢性鼻炎、鼻咽炎和咽炎、牙龈炎和牙周病、咳嗽,并进行了敏感性分析。孟德尔随机化 pleiotropy RESidual Sum 和 Outlier 和 PhenoScanner 工具用于进一步检查异质性结果并去除异常值。经 Bonferroni 校正后,MR 中的逆方差加权(IVW)显示 GERD 和 EED 之间存在显著的因果关系。IVW 结果表明,GERD 增加了慢性鼻炎、鼻咽炎和咽炎(比值比 [OR] = 1.482,95%置信区间 [CI] = 1.267-1.734,P < 0.001)、牙龈炎和牙周病(OR = 1.166,95%CI = 1.046-1.190,P = 0.001)、喉咙和胸痛(OR = 1.585,95%CI = 1.455-1.726,P < 0.001)、哮喘(OR = 1.539,95%CI = 1.379-1.717,P < 0.001)和支气管炎(OR = 1.249,95%CI = 1.168-1.335,P < 0.001)的风险。敏感性分析未检测到混杂。单核苷酸多态性的逐一缺失分析表明,MR 结果不受个体单核苷酸多态性的影响。漏斗图考虑了遗传工具变量几乎对称分布。这项 MR 支持 GERD 和 EED 之间存在因果关系。基于因果关系的精确调节和多学科医生之间的积极合作促进,确保了高质量的诊断和治疗建议,并使患者受益最大化。
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