Comparison of Esophageal Dysmotility and Reflux Burden in Patients with Different Metabolic Obesity Phenotypes Based on High-Resolution Impedance Manometry and 24-h Impedance-pH.

INTRODUCTION: The relationship between the metabolically healthy obesity (MHO) phenotype and the occurrence of gastroesophageal reflux disease (GERD) and inefficient esophageal motility (IEM) is still unclear. Thus, we assessed the association between different metabolic obesity phenotypes and GERD and IEM using empirical data. METHODS: We collected clinical and test data of 712 patients, including 24-h multichannel intraluminal impedance-pH (24-h MII-pH) monitoring, high-resolution manometry (HRM), and endoscopy. We divided 567 individuals into four categories according to their metabolic obesity phenotype: metabolically unhealthy non-obesity (MUNO), metabolically unhealthy obesity (MUO), metabolically healthy non-obesity (MHNO), and MHO. We compared differences in the 24-h MII-pH monitoring, HRM, and endoscopy findings among the four metabolic obesity phenotypes. RESULTS: Patients with the MUNO, MHO, or MUO phenotype showed a greater risk of IEM and GERD (pathologic acid exposure time [AET] >6%) compared with patients with the MHNO phenotype. Regarding the HRM results, patients with the MHNO or MUNO phenotype had a lower integrated relaxation pressure, esophageal sphincter pressure, and esophagogastric junction contractile integral, and more ineffective swallows than patients with the MHO or MUO phenotype (p < 0.05). In terms of 24-h MII-pH, patients with the MHO or MUO phenotype had a higher total, upright, and supine AET; a higher total number of reflux episodes (TRs); and a lower mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index compared with those with the MHNO or MUNO phenotype (all p < 0.05). Considering the odds ratio of 19.086 (95% confidence interval 6.170-59.044) for pathologic AET and 3.659 (95% confidence interval 1.647-8.130) for IEM, patients with the MUO phenotype had the greatest risk after adjusting for all confounding variables. CONCLUSION: Obesity and metabolic disorders increase the risk of GERD and IEM. Obesity has a greater impact on esophageal dysmotility and pathologic acid exposure than metabolic diseases.

Construction of an effective method combining in situ capping with electric field-enhanced biodegradation for treating PAH-contaminated soil at abandoned coking sites.

The simultaneous application of in situ capping and electro-enhanced biodegradation may be a suitable method for ensuring the feasibility and safety of reusing abandoned coking sites. However, the capping layer type and applied electric field pattern may affect the efficiency of sequestering and removing pollutants. This study investigated changes in electric current, soil moisture content and pH, polycyclic aromatic hydrocarbon (PAH) concentration, bacterial number, and microbial community structure and metabolic function during soil remediation at abandoned coking plant sites under different applied electric field patterns and barrier types. The results indicated that polarity-reversal electric field was more conducive to maintaining electric current, soil properties, resulting in higher microbial number, community diversity, and functional gene abundance. At 21d, the mean PAH concentrations in contaminated soil, the capping layer's clean soil and barrier were 78.79, 7.56, and 1.57 mg kg-1 lower than those with a unidirectional electric field, respectively. The mean degradation rate of PAHs in the bio-barrier was 10.12 % higher than that in the C-Fe barrier. In the experiment combining a polarity-reversal electric field and a bio-barrier, the mean PAH concentrations in contaminated soil and the capping layer were 706.68 and 27.15 mg kg-1 lower than those in other experiments, respectively, and no PAHs were detected in the clean soil, demonstrating that the combination of the polarity-reversal electric field and the bio-barrier was effective in treating soil at abandoned coking plant sites. The established method of combining in situ capping with electro-enhanced biodegradation will provide technical support for the treatment and reuse of heavily PAH-contaminated soil at abandoned coking plant sites.

Incorporating body mass index into esophageal manometry metrics and mean nocturnal baseline impedance for the evaluation of gastro-esophageal reflux disease.

This study aims to enhance the effectiveness of high resolution manometry (HRM) and pH-impedance monitoring metrics in distinguishing between gastro-esophageal reflux disease (GERD) and non-GERD. A retrospective propensity score matching (PSM) study was conducted on 643 patients with GERD symptoms. PSM matched 134 GERD patients with 134 non-GERD controls. Body mass index (BMI), intra-esophageal pressure (IEP) and intra-gastric pressure (IGP) were significantly higher in the GERD group compared to the non-GERD group. BMI was correlated with IEP and IGP positively. IGP was positively correlated with esophagogastric (EGJ) pressure (EGJ-P) in participants with EGJ type 1 and 2, but not in participants with EGJ type 3. BMI was correlated with distal MNBI negatively. Logistic regression showed BMI as an independent risk factor for GERD. Receiver operating characteristic curve (ROC) and decision curve analysis (DCA) showed that BMI adjusted EGJ contractile integral (EGJ-CI) and BMI adjusted MNBI were superior to the corresponding original ones in predicting GERD susceptibility. According to the findings, BMI and IGP are the main factors contributing to the development of GERD. BMI affects IEP through the adaptive response of EGJ-P to IGP. Incorporating BMI into the calculations of EGJ-CI and MNBI can improve their ability in predicting GERD susceptibility.

Association Between Different Metabolic Obesity Phenotypes and Erosive Esophagitis: A Retrospective Study.

Background and Aim: Obesity is association with elevated risks of erosive esophagitis (EE), and metabolic abnormalities play crucial roles in its development. The aim of the study was to assess the association between metabolic obesity phenotypes and the risk of EE. Methods: This retrospective study enrolled 11,599 subjects who had undergone upper gastrointestinal endoscopy at the First Affiliated Hospital of Dalian Medical University from January 1, 2008, to December 31, 2023. The enrolled individuals were grouped into four cohorts based on their metabolic health and obesity profiles, namely, metabolically healthy non-obesity (MHNO; n=2134, 18.4%), metabolically healthy obesity (MHO; n=1736, 15.0%), metabolically unhealthy non-obesity (MUNO; n=4290, 37.0%), and metabolically unhealthy obesity (MUO; n=3439, 29.6%). The relationships of the different phenotypes of metabolic obesity with the risks of developing EE in the different sexes and age groups were investigated by multivariate logistic regression analysis. Results: The MUNO, MHO, and MUO cohorts exhibited elevated risks of developing EE than the MHNO cohort. The confounding factors were adjusted for, and the findings revealed that the MUO cohort exhibited the greatest risk of EE, with odds ratios (ORs) of 5.473 (95% CI: 4.181-7.165) and 7.566 (95% CI: 5.718-10.010) for males and females, respectively. The frequency of occurrence of EE increased following an increase in proportion of metabolic risk factors. Subgroup analyses showed that the individuals under and over 60 years of age in the MHO, MUNO, and MUO cohorts exhibited elevated risks of developing EE. Further analysis suggested that obesity has a stronger influence on the risks of developing EE compared to metabolic disorders. Conclusion: Metabolic disorders and obesity are both related with an elevated risk of EE, in which obesity has a potentially stronger influence. Clinical interventions should target both obesity and metabolic disorders to reduce EE risk.

Treatment of PAHs contaminated soil in abandoned industrial site using combined method of improved in situ capping and electrokinetic enhanced-bioremediation.

In situ capping and bioremediation are common technologies for treating contaminated soil at industrial sites. However, these two technologies have some shortcomings for treating soil heavily contaminated with organic matter, such as the limited adsorption in capping layer and the low biodegradation efficiency. This study proposed the method of an improved in situ capping combined with electrokinetic enhanced-bioremediation, and investigated its feasibility for treating heavily polycyclic aromatic hydrocarbons (PAHs) contaminated soil at an abandoned industrial site. By analyzing the changes in soil properties, PAHs concentration, and microbial community in experiments with voltages of 0, 0.8, 1.2, and 1.6 V cm-1, it was found that improved in situ capping could effectively sequester PAHs migration by adsorption and biodegradation, and electric field could enhance PAHs removal from contaminated soil and bio-barrier. In the experiments with electric field, soil environment under the voltage of 1.2 V cm-1 was more favorable for the growth and metabolism of microorganisms, and the residual PAHs concentrations (19.47 ± 0.76 mg kg-1 and 619.38 ± 20.05 mg kg-1) in the bio-barrier and contaminated soil of experiment with 1.2 V cm-1 were the lowest, which indicated that optimization of the electric field conditions could lead to better effects.

Effect of electric fields strength on soil factors and microorganisms during electro-bioremediation of benzo[a]pyrene-contaminated soil.

Electro-bioremediation is a promising technology for remediating soils contaminated with polycyclic aromatic hydrocarbons (PAHs). However, the resulting electrokinetic effects and electrochemical reactions may inevitably cause changes in soil factors and microorganism, thereby reducing the remediation efficiency. To avoid negative effect of electric field on soil and microbes and maximize microbial degradability, it is necessary to select a suitable electric field. In this study, artificial benzo [a]pyrene (BaP)-contaminated soil was selected as the object of remediation. Changes in soil factors and microorganisms were investigated under the voltage of 1.0, 2.0, and 2.5 V cm-1 using chemical analysis, real-time PCR, and high-throughput sequencing. The results revealed noticeable changes in soil factors (pH, moisture, electrical conductivity [EC], and BaP concentration) and microbes (PAHs ring-hydroxylating dioxygenase [PAHs-RHDα] gene and bacterial community) after the application of electric field. The degree of change was related to the electric field strength, with a suitable strength being more conducive to BaP removal. At 70 d, the highest mean extent of BaP removal and PAHs-RHDα gene copies were observed in EK2.0 + BIO, reaching 3.37 and 109.62 times those in BIO, respectively, indicating that the voltage of 2.0 V cm-1 was the most suitable for soil microbial growth and metabolism. Changes in soil factors caused by electric fields can affect microbial activity and community composition. Redundancy analysis revealed that soil pH and moisture had the most significant effects on microbial community composition (P < 0.05). The purpose of this study was to determine the appropriate electric field that could be used for electro-bioremediation of PAH-contaminated soil by evaluating the effects of electric fields on soil factors and microbial communities. This study also provides a reference for efficiency enhancement and successful application of electro-bioremediation of soil contaminated with PAHs.