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IEM is the most prevalent motility abnormality in patients with GERD-associated respiratory symptoms. Coexistence of IEM with GER may place patients at high risk for respiratory symptoms due to the associated delayed esophageal acid clearance seen with this motility abnormality.

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Background and Aims: To eliminate the anti-definition of non-alcoholic fatty liver disease (NAFLD), positive clinical criteria for metabolic associated fatty liver disease are recently proposed. In this study, we examine the validation and utilization of these criteria. METHODS: Two cohorts of 316 consecutive patients were recruited, including 242 patients previously diagnosed to have NAFLD and 74 patients with concomitant NAFLD and chronic hepatitis C (CHC) The validity of the proposed criteria for MAFLD, namely presence of hepatic steatosis with one of three criteria, overweight/obesity, diabetes or evidence of metabolic dysregulation was assessed. Fibrosis was assessed using, fibrosis-4 (FIB-4) and NAFLD fibrosis score (NFS). The impact of MAFLD on the clinical outcomes in CHC patients was also investigated. Results: The clinical criteria captured 240 patients (99.2%). 215 (88.8%) met either overweight or diabetes and 25 (10.3%) met the presence of 2 criteria of metabolic dysfunction. In patients, with dual etiologies, in the multivariable analysis adjusting for age, sex, BMI, ALT, AST and diabetes, the presence of MAFLD were significantly associated with increase high FIB-4 score of fibrosis (Odds ratio [95% confidence interval], 3.77 [1.49-9.48], P < 0.005) when compared to those with MAFLD only. CONCLUSION: The proposed criteria for diagnosis of MAFLD is well validated and easily applicable to the entire spectrum of disease including non-obese subjects. Patients with lean MAFLD have favorable metabolic and fibrosis characteristics compared to their obese counterpart, while patients with concomitant MAFLD and CHC had severe metabolic and fibrosis characteristics compared to patients with MAFLD alone.

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