Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2024; 30(8): 855-862
Published online Feb 28, 2024. doi: 10.3748/wjg.v30.i8.855
Immunoglobulin G-mediated food intolerance and metabolic syndrome influence the occurrence of reflux esophagitis in Helicobacter pylori-infected patients
Li-Hui Wang, Bin-Bin Su, Sheng-Shu Wang, Guan-Chao Sun, Kun-Ming Lv, Yi Li, Hui Shi, Qian-Qian Chen
Li-Hui Wang, Guan-Chao Sun, Kun-Ming Lv, Medical College, Chinese PLA General Hospital, Beijing 100853, China
Li-Hui Wang, Bin-Bin Su, Guan-Chao Sun, Kun-Ming Lv, Hui Shi, Department of Gastroenterology, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Sheng-Shu Wang, Institute of Geriatrics, The 2nd Medical Center, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Yi Li, Qian-Qian Chen, Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Co-first authors: Li-Hui Wang and Bin-Bin Su.
Co-corresponding authors: Qian-Qian Chen and Hui Shi.
Author contributions: Su BB, Lv KM, Li Y, Shi H, and Chen QQ are gastroenterologists; Wang SS is a statistician; Wang LH and Sun GC are master degree candidates; Shi H and Chen QQ performed the disease diagnosis; Wang LH, Su BB, Shi H, and Chen QQ designed the research study; Su BB and Wang SS performed the primary literature and data extraction; Wang LH, Su BB, and Wang SS analyzed the data and wrote the manuscript; Sun GC, Lv KM, Li Y, Shi H, and Chen QQ revised the manuscript for important intellectual content; and all authors read and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the PLA General Hospital (Ethics audits No. S2022-414-01).
Informed consent statement: Patients were not required to provide informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to test by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian-Qian Chen, MD, Associate Chief Physician, Associate Professor, Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. qian_qian_chen@163.com
Received: December 8, 2023
Peer-review started: December 8, 2023
First decision: December 27, 2023
Revised: January 4, 2024
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: February 28, 2024
Abstract
BACKGROUND

Reflux esophagitis has an increasing prevalence and complex and diverse symptoms. Identifying its risk factors is crucial to understanding the etiology, prevention, and management of the disease. The occurrence of reflux esophagitis may be associated with food reactions, Helicobacter pylori (H. pylori) infection, and metabolic syndromes.

AIM

To investigate the risk factors for reflux esophagitis and analyze the effects of immunoglobulin (Ig) G-mediated food intolerance, H. pylori infection, and metabolic syndrome on reflux esophagitis.

METHODS

Outpatients attending the Second Medical Center of the PLA General Hospital between 2017 and 2021 were retrospectively enrolled. The patients’ basic information, test results, gastroscopy results, H. pylori test results, and IgG-mediated food intolerance results were collected. Multivariate logistic regression analysis was used to analyze risk factors for reflux esophagitis. Statistical mediation analysis was used to evaluate the effects of IgG-mediated food intolerance and metabolic syndrome on H. pylori infection affecting reflux esophagitis.

RESULTS

A total of 7954 outpatients were included; the prevalence of reflux esophagitis, IgG-mediated food intolerance, H. pylori infection, and metabolic syndrome were 20.84%, 61.77%, 35.91%, and 60.15%, respectively. Multivariate analysis showed that the independent risk factors for reflux esophagitis included IgG-mediated food intolerance (OR = 1.688, 95%CI: 1.497-1.903, P < 0.00001) and metabolic syndrome (OR = 1.165, 95%CI: 1.030-1.317, P = 0.01484), and the independent protective factor for reflux esophagitis was H. pylori infection (OR = 0.400, 95%CI: 0.351-0.456, P < 0.00001). IgG-mediated food intolerance had a partially positive mediating effect on H. pylori infection as it was associated with reduced occurrence of reflux esophagitis (P = 0.0200). Metabolic syndrome had a partially negative mediating effect on H. pylori infection and reduced the occurrence of reflux esophagitis (P = 0.0220).

CONCLUSION

Patients with IgG-mediated food intolerance and metabolic syndrome were at higher risk of developing reflux esophagitis, while patients with H. pylori infection were at lower risk. IgG-mediated food intolerance reduced the risk of reflux esophagitis pathogenesis in patients with H. pylori infection; however, metabolic syndrome increased the risk of patients with H. pylori infection developing reflux esophagitis.

Keywords: Gastroesophageal reflux, Esophagitis, Food intolerance, Metabolic syndrome, Helicobacter pylori, Chemokines

Core Tip: This retrospective study investigated the effects of IgG-mediated food intolerance, Helicobacter pylori (H. pylori) infection, and metabolic syndrome on reflux esophagitis. In 7954 outpatients, the prevalence of reflux esophagitis was 20.84%. Patients with IgG-mediated food intolerance and metabolic syndrome are at higher risk of developing reflux esophagitis, while patients with H. pylori infection are at lower risk. IgG-mediated food intolerance reduces the risk of reflux esophagitis pathogenesis in patients with H. pylori infection; however, metabolic syndrome increases the risk of patients with H. pylori infection developing reflux esophagitis.