Core symptoms and network analysis in patients with gastroesophageal reflux disease based on body mass index

BACKGROUNDGastroesophageal reflux disease (GERD), a prevalent and difficult-to-manage gastrointestinal disorder, is frequently accompanied by complex symptoms.However, the nature of the relationship between these symptoms remains elusive.Although previous studies have established the impact of body mass index (BMI) on the prevalence of GERD and the severity of specific symptoms, it is still unclear whether the specific symptoms and their relationships vary according to BMI. AIMTo identify core GERD symptoms and determine whether their network structures differ by BMI. METHODSSymptom data were collected from five tertiary hospitals in China, included 438 adults with GERD (mean age 51.08 years, 44.98% female).Network analysis was performed to examine the interaction patterns among 36 symptoms and identify core symptom clusters between the BMI < 25 kg/m² and BMI ≥ 25 kg/m² groups.Additionally, three network properties, namely network structure, strength value, and global strength, were examined across the two BMI groups. RESULTSAmong the subjects, depression and bloating constituted the primary core symptoms.In the BMI ≥ 25 kg/m² group, anxiety, shortness of breath, and abdominal distension were symptoms of significant influence.However, nausea, foreign body sensation in the throat, and nocturnal reflux exerted a considerable impact in the BMI < 25 kg/m² group.Lastly, the overall symptom structure and correlations were similar across the BMI groups.5 / 35 CONCLUSION Depression and bloating occupy central positions in GERD symptom networks regardless of BMI, while other influential symptoms vary by subgroup.These findings provide novel insights for personalized, BMI-based symptom interventions.