Takahashi Kazuya, Sato Hiroki, Shimamura Yuto, Abe Hirofumi, Shiwaku Hironari, Shiota Junya, Sato Chiaki, Satomi Takuya, Ominami Masaki, Hata Yoshitaka, Fukuda Hisashi, Ogawa Ryo, Nakamura Jun, Tatsuta Tetsuya, Ikebuchi Yuichiro, Terai Shuji, Inoue Haruhiro
Division of Gastroenterology & Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 757-1, Asahimachidori, Chuo-Ku, Niigata, Niigata, 951-8510, Japan.
Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
J Gastroenterol. 2025 May;60(5):535-545. doi: 10.1007/s00535-024-02205-9. Epub 2024 Dec 31.
The distribution of body weight in patients with achalasia and after peroral endoscopic myotomy (POEM) has not been investigated. The role of body weight assessment after treatment remains unclear.
Using the multicenter achalasia cohort, the frequency of underweight (body mass index [BMI] < 18.5 kg/m) and overweight (BMI ≥ 25.0 kg/m) and their associated clinical characteristics were analyzed. After POEM, risk factors for insufficient- (underweight persistently) and excessive- (responded to overweight) weight gainers were investigated. The correlation between BMI-increase rate and severity of esophageal symptoms post-POEM was evaluated.
Among 3,410 patients, 23.0% and 15.7% were underweight and overweight, respectively. Factors associated with underweight were higher age, female sex, severe symptoms, high lower esophageal sphincter (LES) pressure, and non-dilated esophagus (all p < 0.01). Longitudinal analyses revealed that weight gain post-POEM was achieved after a long duration (≥ 12 months; p < 0.01). In 528 patients post-POEM, the frequency of underweight reduced to 8.3% (p < 0.01). Risk factors for insufficient-weight gain (36.1% of underweight patients) included low BMI (p < 0.01) and high LES pressure (p = 0.03) and conversely for excessive-weight gain. Machine learning models based on patient characteristics successfully predicted insufficient- and excessive-weight gainers with an area under the curve value of 0.74 and 0.75, respectively. Esophageal symptoms post-POEM did not correlate with BMI increase.
Underweight is not solely a condition of advanced achalasia. After POEM, insufficient- or excessive-weight gainers are not rare and can be predicted preoperatively. Body weight change is an independent nutrition parameter rather than a part of the assessment of residual esophageal symptoms.
贲门失弛缓症患者及经口内镜下肌切开术（POEM）后的体重分布情况尚未得到研究。治疗后体重评估的作用仍不明确。
利用多中心贲门失弛缓症队列，分析体重过轻（体重指数[BMI]<18.5kg/m²）和超重（BMI≥25.0kg/m²）的频率及其相关临床特征。POEM术后，研究体重增加不足（持续体重过轻）和体重增加过多（体重超重）的危险因素。评估POEM术后BMI增加率与食管症状严重程度之间的相关性。
在3410例患者中，体重过轻和超重的患者分别占23.0%和15.7%。与体重过轻相关的因素包括年龄较大、女性、症状严重、食管下括约肌（LES）压力高和食管未扩张（所有p<0.01）。纵向分析显示，POEM术后体重增加是在较长时间（≥12个月；p<0.01）后实现的。在528例POEM术后患者中，体重过轻的频率降至8.3%（p<0.01）。体重增加不足的危险因素（占体重过轻患者的36.1%）包括低BMI（p<0.01）和高LES压力（p=0.03），体重增加过多则相反。基于患者特征的机器学习模型成功预测了体重增加不足和体重增加过多的患者，曲线下面积值分别为0.74和0.75。POEM术后食管症状与BMI增加无关。
体重过轻并非晚期贲门失弛缓症的独有情况。POEM术后，体重增加不足或过多的情况并不罕见，且可在术前进行预测。体重变化是一个独立的营养参数，而非残余食管症状评估的一部分。
