Epidemiological Investigation Of Gastroesophageal Reflux Disease In Gansu Province And Explore Its Relationship With Intestinal Microecology

Objective:1.To investigate the condition of Gastroesophageal Reflux Disease(GERD)in Gansu Province,explore the related risk factors and construct a nomogram model of GERD risk and evaluate its efficacy;2.To analyze the composition of the intestinal flora of GERD patients and healthy controls,and to explore the clinical significance of the change of intestinal flora in GERD.Methods:From October 2021 to May 2022,multi-center cooperation are selected for epidemiological investigation,including Lanzhou,Tianshui,Longnan,Wuwei,Zhangye,Gannan Tibetan autonomous region and Linxia Hui autonomous region,and the study subjects were determined by multi-stage stratified cluster random sampling method.For adults in the sampled area(age 18 years)who had lived locally for more than 3 years,trained investigators conducted questionnaires to record the basic information of the respondents and the exposure to possible risk factors for GERD.at the same time,Predictive model using the R language based on risk factors,And using the receiver operating characteristics(receiver operating characteristic,ROC)The area under the curve(area under the curve,AUC)and the calibration map to evaluate the prediction efficiency;Secondly,to explore the relationship between GERD and H.pylori,325 patients diagnosed with GERD and 285 people with a physical examination at the same time were selected as the observation group to compare the differences in the prevalence of H.pylori between two groups and different subtypes of GERD;At the same time,30 subjects were included in the GERD group and 30subjects in the control group,and their stool samples were collected.16S-r RNA was used to detect the intestinal flora structure of the subjects,and the differences were analyzed.Meanwhile,peripheral blood was extracted for T cell subsets analysis.Results:1.A total of 4711 valid questionnaires were recovered(response rate was92.3%),including 2425 men and 2286 women,aged 18-89 years,with a mean age of39.25±14.81 years.According to the GERD-Q score 8,which was a cut-off value,the standardized prevalence of GERD in Gansu Province was 10.34%,and the prevalence in men was 11.46%(278/2425)was higher than that in women 9.14%(196/2286),and the difference was statistically significant(P<0.05).The prevalence of GERD between 50-59 years and 60 years was significantly higher than that of those aged<50 years(P<0.05);The prevalence of GERD was positively associated with BMI;when BMI was≥24 Kg/m~2,the prevalence of GERD was significantly increased;the prevalence of Han,Hui and Tibetan was 10.03%,1.11.89%and 13.31%,respectively,with no significant difference among ethnic groups(P>0.05).The binary logistic multivariate regression analysis showed that men,age 50 years,BMI≥24Kg/m~2,smoking,drinking,sweet food,eating 2 hours before bedtime,HP infection,gastroduodenal ulcer or inflammation,pharyngitis,precardiac pain and peripheral vertigo were all independent risk factors for GERD(P<0.05);while high-fat diet,acidic drink intake,spicy diet,asthma,chronic cough,appendicitis and abdominal surgery had no significant correlation with the occurrence of GERD(P>0.05).According to the above risk factors,the nomogram prediction model was established.C index and AUC were 0.736 and 0.742 in the training set and validation set,respectively,and the correction curve fit well;2.The infection rate of Hp in the observed and control groups was 52.4%and 56.6%.There was no significant statistical difference between the two groups(P>0.05),but the infection rate of Helicobacter pylori in patients with reflux esophagitis was 41.1%,which was statistically significant compared with the control group(χ~2=11.387,P<0.05).2.A total of 60 qualified serum and stool samples were collected,There was no significant difference in T cell detection between the two groups(P>0.05);There is no significant differences were found about Alpha diversity comparison(P>0.05);While the beta diversity analysis showed a significant difference in the flora structure between the two groups(P<0.05),Further differences between the two groups using linear discriminant analysis(LEFse analysis),In contrast to the healthy controls,GERD patient group decreased abundance of Bifidobacterium,Rochella,Lactococcus,Ackermania,Enterobacter,Weisella,Adler,Cholophila,and Mideberella;The genus Micrococcus Veronella,pneumococcus,monomonas,Maasai,Paranspella,and node bacteria increased significantly.Conclusion:The incidence of GERD in Gansu Province is high and affected by many factors.Male sex,age 50 years,smoking,like sweets,eating too full and eating 2hours before bedtime may be related with the prevalence of GERD in Gansu Province.The prediction accuracy of the nomogram model established according to the data of this group is appropriate,which can provide some help for medical workers to quickly identify high-risk groups and make clinical decisions.In patients with reflux esophagitis,H.pylori infection decreases with increasing disease grade and may have the effect of delaying disease progression.Compared with the healthy control group,the intestinal microecology of the GERD group was significantly changed,which may be related to the occurrence and development of the disease,and expected to provide some new ideas for the treatment of GERD.