ArticleFrontiers in endocrinology2026
Metabolic correlates of endoscopy-confirmed reflux esophagitis in hospital-based patients with type 2 diabetes mellitus.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reflux esophagitis (RE) is an endoscopy-defined manifestation of gastroesophageal reflux disease and may be related to metabolic disturbance in type 2 diabetes mellitus (T2DM). The clinical-metabolic characteristics associated with endoscopy-confirmed RE in T2DM remain incompletely defined, particularly with regard to glycemic control, 25-hydroxyvitamin D [25(OH)D] status, and insulin-related indicators. This study evaluates the joint associations of these metabolic factors with endoscopy-confirmed RE in a hospital-based T2DM population. Methods: The analytic cohort comprises 772 hospital-based patients with T2DM and ascertainable RE status from endoscopic diagnostic records. Demographic characteristics, diabetes-related complications, glycemic indices, lipid parameters, renal function, 25(OH)D, insulin-related indicators, and gastrointestinal test findings are assessed. Prespecified multivariable logistic regression models are applied to identify clinical-metabolic correlates of RE. Restricted cubic spline analyses are used to assess potential nonlinear associations, and exploratory discrimination analyses are performed to evaluate risk-stratification performance. Results: Among 772 patients, 223 are classified as having RE, corresponding to an observed prevalence of 28.9%. Compared with the non-RE group, the RE group has higher HbA1c, fasting insulin, triglycerides, HOMA-IR, fasting-state ISI, and TyG index, and lower 25(OH)D levels. In fully adjusted models, HbA1c remains consistently associated with RE (adjusted odds ratio [aOR] per 1-standard-deviation increase, 1.58; 95% confidence interval [CI], 1.33-1.87). The inverse association between 25(OH)D and RE attenuates after adjustment for HbA1c and TyG index (aOR, 0.84; 95% CI, 0.70-1.00). The TyG index provides limited additional information after HbA1c adjustment (aOR, 1.02; 95% CI, 0.85-1.21), whereas HOMA-IR, fasting insulin, and fasting-state ISI show positive associations with RE when evaluated separately. Restricted cubic spline analyses indicate nonlinear associations for HbA1c and insulin-related indicators, with stronger metabolic signals at higher value ranges. Exploratory discrimination analyses indicate limited-to-moderate risk-stratification performance. Conclusion: In hospital-based patients with T2DM, endoscopy-confirmed RE is associated with an adverse clinical-metabolic profile, mainly characterized by higher HbA1c and selected insulin-related abnormalities. The inverse association between 25(OH)D and RE attenuates after glycemic adjustment and requires cautious interpretation. These cross-sectional findings are associational and hypothesis-generating, and prospective studies are needed to clarify temporal relationships and clinical implications.
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