He Tao, Zhang Mingjie, Tong Menghan, Duan Zhijun
Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Dalian Central Laboratory of Integrative Neuro-Gastrointestinal Dynamics and Metabolism Related Diseases Prevention and Treatment, Dalian, China.
Obes Facts. 2024;17(6):629-640. doi: 10.1159/000541130. Epub 2024 Aug 29.
The relationship between the metabolically healthy obesity (MHO) phenotype and the occurrence of gastroesophageal reflux disease (GERD) and inefficient esophageal motility (IEM) is still unclear. Thus, we assessed the association between different metabolic obesity phenotypes and GERD and IEM using empirical data.
We collected clinical and test data of 712 patients, including 24-h multichannel intraluminal impedance-pH (24-h MII-pH) monitoring, high-resolution manometry (HRM), and endoscopy. We divided 567 individuals into four categories according to their metabolic obesity phenotype: metabolically unhealthy non-obesity (MUNO), metabolically unhealthy obesity (MUO), metabolically healthy non-obesity (MHNO), and MHO. We compared differences in the 24-h MII-pH monitoring, HRM, and endoscopy findings among the four metabolic obesity phenotypes.
Patients with the MUNO, MHO, or MUO phenotype showed a greater risk of IEM and GERD (pathologic acid exposure time [AET] >6%) compared with patients with the MHNO phenotype. Regarding the HRM results, patients with the MHNO or MUNO phenotype had a lower integrated relaxation pressure, esophageal sphincter pressure, and esophagogastric junction contractile integral, and more ineffective swallows than patients with the MHO or MUO phenotype (p < 0.05). In terms of 24-h MII-pH, patients with the MHO or MUO phenotype had a higher total, upright, and supine AET; a higher total number of reflux episodes (TRs); and a lower mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index compared with those with the MHNO or MUNO phenotype (all p < 0.05). Considering the odds ratio of 19.086 (95% confidence interval 6.170-59.044) for pathologic AET and 3.659 (95% confidence interval 1.647-8.130) for IEM, patients with the MUO phenotype had the greatest risk after adjusting for all confounding variables.
Obesity and metabolic disorders increase the risk of GERD and IEM. Obesity has a greater impact on esophageal dysmotility and pathologic acid exposure than metabolic diseases.
代谢健康型肥胖（MHO）表型与胃食管反流病（GERD）及食管动力障碍（IEM）的发生之间的关系仍不明确。因此，我们使用实证数据评估了不同代谢性肥胖表型与GERD和IEM之间的关联。
我们收集了712例患者的临床和检查数据，包括24小时多通道腔内阻抗-pH（24小时MII-pH）监测、高分辨率测压（HRM）和内镜检查。我们根据567名个体的代谢性肥胖表型将其分为四类：代谢不健康的非肥胖者（MUNO）、代谢不健康的肥胖者（MUO）、代谢健康的非肥胖者（MHNO）和MHO。我们比较了四种代谢性肥胖表型在24小时MII-pH监测、HRM和内镜检查结果方面的差异。
与MHNO表型的患者相比，MUNO、MHO或MUO表型的患者发生IEM和GERD（病理性酸暴露时间[AET]＞6%）的风险更高。关于HRM结果，与MHO或MUO表型的患者相比，MHNO或MUNO表型的患者综合松弛压、食管括约肌压力和食管胃交界处收缩积分更低，无效吞咽更多（p＜0.05）。在24小时MII-pH方面，与MHNO或MUNO表型的患者相比，MHO或MUO表型的患者总AET、直立位AET和仰卧位AET更高；反流发作总数（TRs）更高；夜间平均基线阻抗和反流后吞咽诱发蠕动波指数更低（所有p＜0.05）。考虑到病理性AET的比值比为19.086（95%置信区间6.170-59.044），IEM的比值比为3.659（95%置信区间1.647-8.130），在对所有混杂变量进行校正后，MUO表型的患者风险最大。
肥胖和代谢紊乱会增加GERD和IEM风险。肥胖对食管动力障碍和病理性酸暴露的影响大于代谢性疾病。
