Pan Chaofan, Lin Mingzhi, Luo Wenbin, Li Ruoyun, Luo Changjiang
The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China.
Medicine (Baltimore). 2024 Dec 13;103(50):e40859. doi: 10.1097/MD.0000000000040859.
Hiatal hernia (HH) is a common gastrointestinal disorder characterized by the displacement of abdominal contents, particularly the stomach, into the thoracic cavity. This condition is frequently associated with gastroesophageal reflux disease (GERD) and can lead to various symptoms, including chronic cough and respiratory issues. Despite its prevalence, the mechanisms linking psychological factors to HH are not well understood. Observational studies have suggested correlations between mental health issues - such as stress, anxiety, and depression - and gastrointestinal disorders, indicating that emotional states may influence the development of HH. This study aims to clarify the causal relationships between mood swings, depression, and the risk of developing HH using Mendelian randomization (MR), a robust method that utilizes genetic variants as instrumental variables (IVs) to infer causality. Data for this MR analysis were obtained from publicly available genome-wide association studies (GWAS). We employed a bidirectional, 2-sample MR approach, using IVs associated with mood swings, depression, feelings of tension, and feelings of misery as exposures, with HH as the outcome. A reverse MR analysis was also conducted, treating HH as the exposure and the aforementioned emotional states as outcomes. The primary analytical method used was inverse variance weighting (IVW), supplemented by sensitivity analyses, including MR-Egger and weighted median methods. Our analysis revealed significant associations: mood swings (OR = 1.014; 95% CI = 1.001-1.027; P = .032), depression (OR = 1.019; 95% CI = 1.006-1.033; P = .003), feelings of tension (OR = 1.012; 95% CI = 1.004-1.020; P = .001), and feelings of misery (OR = 1.007; 95% CI = 1.003-1.010; P = .0001) significantly increased the risk of HH. Importantly, reverse MR analysis indicated no causal influence of HH on these emotional states. This study provides evidence that mood swings, depression, feelings of tension, and feelings of misery are significant risk factors for developing HH. These findings highlight the need to address psychological factors in the clinical management and prevention strategies for HH, potentially improving patient outcomes.
食管裂孔疝（HH）是一种常见的胃肠疾病，其特征是腹腔内容物，尤其是胃，移位至胸腔。这种情况常与胃食管反流病（GERD）相关，并可导致多种症状，包括慢性咳嗽和呼吸问题。尽管其发病率较高，但心理因素与HH之间的关联机制尚未完全明确。观察性研究表明，心理健康问题，如压力、焦虑和抑郁，与胃肠疾病之间存在相关性，这表明情绪状态可能影响HH的发生发展。本研究旨在利用孟德尔随机化（MR）方法阐明情绪波动、抑郁与HH发病风险之间的因果关系，MR是一种强大的方法，利用基因变异作为工具变量（IV）来推断因果关系。本MR分析的数据来自公开可用的全基因组关联研究（GWAS）。我们采用双向双样本MR方法，将与情绪波动、抑郁、紧张感和痛苦感相关的IV作为暴露因素，HH作为结局。还进行了反向MR分析，将HH作为暴露因素，将上述情绪状态作为结局。主要分析方法采用逆方差加权（IVW），并辅以敏感性分析，包括MR-Egger和加权中位数方法。我们的分析显示出显著关联：情绪波动（OR = 1.014；95%CI = 1.001 - 1.027；P = 0.032）、抑郁（OR = 1.019；95%CI = 1.006 - 1.033；P = 0.003）、紧张感（OR = 1.012；95%CI = 1.004 - 1.020；P = 0.001）和痛苦感（OR = 1.007；95%CI = 1.003 - 1.010；P = 0.0001）显著增加了HH的发病风险。重要的是，反向MR分析表明HH对这些情绪状态没有因果影响。本研究提供了证据，证明情绪波动、抑郁、紧张感和痛苦感是HH发生的重要危险因素。这些发现凸显了在HH的临床管理和预防策略中关注心理因素的必要性，这可能会改善患者的治疗效果。
