He Tao, Su Li-Ping, Song Shun-Zhe, Li Yu-Fei, Wang Li-Xia, Sun Shan-Ming
Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Liaoning, China.
Department of Gastroenterology, Weifang People's Hospital, Shandong Second Medical University, Shandong, China.
Turk J Gastroenterol. 2025 Feb 11;36(6):371-380. doi: 10.5152/tjg.2025.24351.
BACKGROUND/AIMS: Obesity correlates with a higher prevalence of gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM); however, the connection between metabolic obesity phenotype and these symptoms is poorly explored. Here, empirical data were used to explore the relationships between phenotypes of metabolic obesity and GERD and IEM.
The present retrospective study involved 605 patients demonstrating typical reflux symptoms, categorized into 4 phenotypes: metabolically healthy obesity (MHO), metabolically healthy non-obesity (MHNO), metabolically unhealthy obesity (MUO), and metabolically unhealthy non-obesity (MUNO). The study excluded cases who were underweight, with severe comorbidities, prior gastric surgeries, or an absence of complete data. A 24-hour multichannel intraluminal impedance-pH system was used for monitoring.
Patients exhibiting MUO, MHO, and MUNO phenotypes demonstrated a higher risk of GERD (pathological acid exposure time (AET), >6%) and IEM compared to those with the MHNO phenotype. Potential confounders, such as sex, age, body mass index, waist-hipratio, smoking status, alcohol intake, psychosocial stress, socioeconomic status, dietary practices, and opioid usage were adjusted, with the results indicating that the MUO phenotype was linked to the highest risk of pathological AET [15.78 (95% CI: 4.72-52.73)]; IEM [3.00 (95% CI: 1.31-6.87)].
The effects of obesity on GERD and IEM incidence could exceed those of metabolic diseases.
背景/目的：肥胖与胃食管反流病（GERD）和食管动力障碍（IEM）的较高患病率相关；然而，代谢性肥胖表型与这些症状之间的联系鲜有研究。在此，通过实证数据来探究代谢性肥胖表型与GERD和IEM之间的关系。
本回顾性研究纳入了605例有典型反流症状的患者，分为4种表型：代谢健康型肥胖（MHO）、代谢健康型非肥胖（MHNO）、代谢不健康型肥胖（MUO）和代谢不健康型非肥胖（MUNO）。研究排除了体重过轻、有严重合并症、既往有胃部手术史或数据不完整的病例。使用24小时多通道腔内阻抗-pH系统进行监测。
与MHNO表型的患者相比，表现出MUO、MHO和MUNO表型的患者发生GERD（病理性酸暴露时间（AET），>6%）和IEM的风险更高。对性别、年龄、体重指数、腰臀比、吸烟状况、饮酒量、心理社会压力、社会经济地位、饮食习惯和阿片类药物使用等潜在混杂因素进行了调整，结果表明MUO表型与病理性AET的最高风险相关[15.78（95%CI：4.72-52.73）]；IEM[3.00（95%CI：1.31-6.87）]。
肥胖对GERD和IEM发病率的影响可能超过代谢性疾病。
