Aerobic exercise and caloric reduction should be the key lifestyle modifications in obese patients with GERD
Bibliographic record
Abstract
We read with interest the paper by Hsu et al. on the relationship between metabolic syndrome and GERD in which they describe an association between insulin resistance and reflux symptoms and the prevalence of erosive oesophagitis.1 Well-designed studies from Taiwan have previously shown that male gender, smoking and the presence of metabolic syndrome are associated with an increased risk of developing erosive oesophagitis and an increased risk of transitioning from non-erosive reflux disease to erosive reflux oesophagitis.2 A case-control study performed in 7078 patients undergoing routine health evaluations in Korea showed that among the individual components of metabolic syndrome, waist circumference (OR = 1.47; 95% CI, 1.30–1.65) and serum triglycerides (OR = 1.20; 95% CI, 1.05–1.36) independently increased the risk for reflux oesophagitis.3 Studies in American women have demonstrated that even modest weight loss may be associated with an improvement in symptoms of GERD.4 In an apparently healthy Canadian population study, the prevalence of the metabolic syndrome was 16.9%.5 Of the 105 participants with the metabolic syndrome at baseline, 30.5% were no longer classified as having the metabolic syndrome after the exercise training. In morbidly obese patients, physical exercise and caloric restriction have been shown to significantly decrease inflammatory markers associated with coronary artery disease and reduce insulin resistance.6 Current guidelines in reflux disease do not emphasise identification of the metabolic syndrome or visceral obesity as potential targets for therapy. The overall health of the patient would improve, and the symptoms and complications of gastro-oesophageal reflux would decrease if exercise and reductions in caloric intake were made a major therapeutic recommendation in obese patients with GERD. Declaration of personal interests: Nimish Vakil has acted as a consultant to AstraZeneca, Otsuka, Orexo, Salix Pharmaceuticals, Shire, Takeda and Xenoport. He has also provided expert testimony for AstraZeneca, and has received financial support for research from Xenoport. He has also received manuscript preparation fees from GlaxoSmithKline and payment for development of educational presentations (including service on speakers? bureaus) from Takeda. He owns stock options in Orexo and Meridian. Declaration of funding interests: None.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".