肥胖胃食管反流病患者的食管动力特征和质子泵抑制剂疗效分析

Characteristics of Esophageal Motility and Efficacy of Proton Pump Inhibitors in Obese Patients With Gastroesophageal Reflux Disease

背景:肥胖是胃食管反流病(GERD)的独立危险因素,但其机制仍不明确。目前关于标准剂量质子泵抑制剂(PPI)治疗肥胖GERD患者有效性的研究尚少。目的:研究肥胖对GERD患者食管动力和酸反流的影响,评估标准剂量PPI对肥胖GERD患者的疗效。方法:2017年1月—2021年10月就诊于安徽省立医院,初诊为GERD并符合入选标准的患者纳入本研究。比较体质指数(BMI)正常和肥胖(BMI≥28.0 kg/m2)GERD患者PPI治疗前的食管高分辨率测压和24 h食管pH‑阻抗监测结果,以及2组患者接受标准剂量PPI(艾司奥美拉唑40 mg qd)治疗8周后的反流性疾病问卷(RDQ)评分变化和临床疗效。结果:共136例GERD患者纳入分析,其中BMI正常对照组102例,肥胖组34例。与对照组相比,肥胖组下食管括约肌(LES)长度缩短,胃食管压力梯度(GEPG)、长反流次数、食管酸暴露时间(AET)百分比和DeMeester评分增高(P均<0.05)。肥胖组治疗前RDQ评分高于对照组(P<0.05),经标准剂量PPI治疗8周后,对照组RDQ评分(7.86±2.53对12.03±4.12,P<0.05)和症状改善总有效率(83.3%对58.8%,P<0.05)均优于肥胖组。结论:肥胖GERD患者有着更严重的食管动力异常、食管酸暴露和反流症状,这可能是标准剂量PPI治疗对于此类患者疗效较差的原因之一。LES长度缩短和GEPG增加可能是肥胖患者食管酸暴露增加的潜在因素。

Background:Obesity is an independent risk factor for gastroesophageal reflux disease(GERD),but the mechanism remains unclear.There are few studies focusing on the effectiveness of standard dose proton pump inhibitor(PPI)in treating obese GERD patients.Aims:To investigate the effect of obesity on esophageal motility and acid reflux in GERD patients and the efficacy of standard dose PPI in treating obese GERD patients.Methods:Patients who were initially diagnosed as GERD and met the inclusion criteria from January 2017 to October 2021 at Anhui Provincial Hospital were included in this study.The results of esophageal high‑resolution manometry and 24 h esophageal pH‑impedance monitoring before PPI treatment in patients with normal body mass index(BMI)and obesity(BMI≥28.0 kg/m2)were compared.Furthermore,the changes in Reflux Disease Questionnaire(RDQ)score and the clinical efficacy in these two groups after 8 weeks of treatment with standard dose PPI(esomeprazole 40 mg qd)were analyzed.Results:A total of 136 patients with GERD were included,102 in normal BMI control group and 34 in obese group.Compared with patients in control group,patients in obese group had shorter lower esophageal sphincter(LES)length,higher gastroesophageal pressure gradient(GEPG),much greater number of reflux episodes≥5 min,and increased percentage of esophageal acid exposure time(AET)and DeMeester score(all P<0.05).The RDQ score was higher in obese group than in control group before treatment(P<0.05).After 8‑week standard dose PPI treatment,both the RDQ score(7.86±2.53 vs.12.03±4.12,P<0.05)and the overall efficacy for symptom improvement(83.3%vs.58.8%,P<0.05)in control group were superior to those in obese group.Conclusions:Obese GERD patients have more severe esophageal dysmotility,abnormal acid exposure and reflux symptoms,which may explain the lower efficacy of standard dose PPI in these patients.Shortened LES length and increased GEPG might be the potential determinants of increased esophageal acid exposure in obese patients.