Obesity and GERD impair esophageal epithelial permeability through 2 distinct mechanisms.

Autor: Blevins CH; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA., Dierkhising RA; Division of Biomedical Statistics and Informatics, Mayo Clinic Minnesota, Rochester, MN, USA., Geno DM; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA., Johnson ML; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA., Vela MF; Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA., Ravi K; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA., Iyer PG; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA., Katzka DA; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2018 Oct; Vol. 30 (10), pp. e13403. Date of Electronic Publication: 2018 Jul 30.
DOI: 10.1111/nmo.13403
Abstrakt: Background: The mechanism by which obesity leads to damage independent of reflux is unclear. We aimed to determine the influence of obesity on mean nocturnal baseline impedance (MNBI), a functional measure of the epithelial barrier, in the presence and absence of acid reflux, using ambulatory pH impedance measurements.
Methods: Twenty-four-hour pH impedance studies performed off medications in Caucasian men with a normal endoscopic examination were assessed for level of acid exposure and MNBI. Four patient groups were studied: Group 1, Not obese and normal acid exposure; Group 2, Obese and normal acid exposure; Group 3, Not obese and increased acid exposure; and Group 4, Obese with increased acid exposure.
Results: One hundred patients were studied (25 in each group). Mean esophageal mucosal impedance (MI) was substantially lower in obese patients without reflux (Group 2) and non-obese patients with reflux (Group 3) compared to normal controls (non-obese, no reflux, Group 1). MI was progressively lower in the distal (vs the proximal) esophagus in GER patients, compared to those without GER. This difference persisted in the presence or absence of obesity. In contrast, in obese patients, the mean MI was significantly lower throughout the esophagus when compared to the non-obese patients and also persisted in the presence and absence of accompanying reflux. Obesity and reflux were both independently negatively correlated with MI.
Conclusion: Obesity is associated with abnormal esophageal MNBI. In contrast to gastro-esophageal reflux, this decrease is pan-esophageal. These data may support a systemic mechanism by which obesity alters the esophageal barrier function.
(© 2018 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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