Clinical characteristics and risk factors of esophageal reflux hypersensitivity: A multicenter study

doi:10.3748/wjg.v31.i17.105281

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. May 7, 2025; 31(17): 105281
Published online May 7, 2025. doi: 10.3748/wjg.v31.i17.105281

Clinical characteristics and risk factors of esophageal reflux hypersensitivity: A multicenter study

Yan-Ping Wu, Jia-Xuan Zhou, Hong-Bo Wu, Di-Ping Wu, Ling-Zhi Qin, Bin Qin, Xiao-Yu Xu, Saleh Abdulaziz Abdulgani Yehya, Yan Cheng

Yan-Ping Wu, Jia-Xuan Zhou, Hong-Bo Wu, Ling-Zhi Qin, Bin Qin, Xiao-Yu Xu, Saleh Abdulaziz Abdulgani Yehya, Yan Cheng, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, Shaanxi Province, China

Di-Ping Wu, Department of Cyberspace Security, Beijing Electronic Science and Technology Institute, Beijing 100000, China

Author contributions: Cheng Y contributed to the conceptualization and supervision of the manuscript; Wu YP was involved in the validation of this study; Wu YP, Zhou JX, and Wu HB participated in the data curation; Wu YP and Zhou JX contributed to the investigation; Wu YP and Wu DP took part in the visualization; Wu YP and Qin LZ contributed to the writing - original draft preparation; Qin B contributed to the methodology of the manuscript; Xu XY was responsible to the software; Yehya SAA contributed to the writing - reviewing and editing.

Supported by the Foundation of the Second Affiliated Hospital of Xi’an Jiaotong University, No. YJ(ZD)202301.

Institutional review board statement: The Institutional Review Board of the Second Affiliated Hospital of Xi’an Jiaotong University approved the study (Approval number: 2023262).

Informed consent statement: Informed consent was obtained from all participants in this study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Yan Cheng, PhD, Chief Physician, Professor, Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 Xiwu Street, Xi’an 710000, Shaanxi Province, China. 15609264849@163.com

Received: January 17, 2025
Revised: March 7, 2025
Accepted: April 17, 2025
Published online: May 7, 2025
Processing time: 102 Days and 17.7 Hours

Abstract

BACKGROUND

Reflux hypersensitivity (RH) constitutes roughly 14% of patients with heartburn and 34% of those with refractory heartburn, yet it is inadequately comprehended.

AIM

To investigate the clinical characteristics and risk factors associated with RH.

METHODS

We conducted a retrospective analysis of 109 patients with RH and 384 healthy controls from three medical centers between January 2022 and December 2023. Comprehensive data encompassing symptoms, motility, impedance-pH monitoring, and psychological evaluations were collected.

RESULTS

RH patients encountered a greater frequency of weakly acidic reflux (WAR) events compared to acidic reflux or nonacidic reflux (NAR) events. Upright reflux time (1.22%) exceeds supine reflux time (0.54%) (P < 0.05). Extraesophageal symptoms were more prevalent among younger patients and those with elevated NAR (P < 0.05). The acidic reflux, WAR, NAR, and peristaltic contraction break length in male patients exceeded those in female patients (P < 0.05). Age [odds ratio (OR) = 5.633], hiatal hernia (OR = 13.103), and anxiety (OR = 17.342) constituted independent risk factors for RH.

CONCLUSION

WAR and NAR are pivotal in RH. Patients with increased NAR are more likely to experience extraesophageal symptoms. Age, hiatal hernia, and anxiety are significant independent risk factors for RH.

Keywords: Gastroesophageal reflux disease; Functional esophageal disease; Reflux hypersensitivity; Clinical characteristics; Risk factors

Core Tip: Reflux hypersensitivity (RH) significantly contributes to heartburn. However, its underlying mechanisms are not fully comprehended. This retrospective study examined data from 92 patients diagnosed with RH and 104 healthy controls to explore clinical characteristics and potential risk factors. The results demonstrate that weakly acidic reflux and nonacidic reflux are integral to the pathophysiology of RH. Furthermore, extraesophageal symptoms were correlated with a younger age and elevated levels of nonacidic reflux. Independent risk factors identified for RH encompass age, the existence of a hiatal hernia, and anxiety. These findings highlight the intricate relationship between reflux subtypes and psychological factors in RH, offering new perspectives for individualized diagnostic and therapeutic strategies.