Centre de recherche, Centre de pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, QC, Canada.
Centre de recherche, Centre de pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, QC, Canada.
Chest. 2019 Jan;155(1):33-43. doi: 10.1016/j.chest.2018.07.038. Epub 2018 Aug 16.
The relationship between gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) is controversial. Current guidelines recommend that clinicians use regular antacid treatment, while two recent meta-analyses of antacid therapy in IPF were inconclusive. The objective of this study was to examine the evidence regarding the association between GERD and IPF through a systematic review and a meta-analysis, with special reference to the methodologic quality of the observational studies.
The MEDLINE, EMBASE, Ovid, and Web of Science (1966-May 2018) databases were searched for original articles published in any language, and we then systematically reviewed the bibliographies of the retrieved articles. Observational studies (cohort and case-control studies) were selected if they allowed the calculation of a measure of association relating GERD to IPF.
Eighteen case-control studies including 3,206 patients with IPF and 9,368 control subjects met the inclusion criteria of the meta-analysis. The meta-analysis indicated that GERD is associated with IPF (OR, 2.94 [95% CI, 1.95-4.42]; P homogeneity < .0001). Overall, the results remained consistent whatever the data source (clinical studies vs databases) or the type of control subject (healthy volunteers, patients with respiratory diseases other than interstitial lung disease, or patients with non-IPF interstitial lung disease). In a meta-regression, after controlling for smoking, GERD and IPF were not related.
GERD and IPF may be related, but this association is most likely confounded, especially by smoking. Our confidence in the estimate of association is low because it is exclusively from case-control studies.
PROSPERO; No.: CRD42016053728; URL: http://www.crd.york.ac.uk/PROSPERO.
胃食管反流病（GERD）与特发性肺纤维化（IPF）之间的关系存在争议。目前的指南建议临床医生使用常规抗酸治疗，而最近对 IPF 抗酸治疗的两项荟萃分析尚无定论。本研究的目的是通过系统评价和荟萃分析来检查 GERD 与 IPF 之间关联的证据，并特别关注观察性研究的方法学质量。
检索了 MEDLINE、EMBASE、Ovid 和 Web of Science（1966 年 5 月至 2018 年）数据库，以获取任何语言发表的原始文章，并系统地查阅了检索文章的参考文献。如果观察性研究（队列和病例对照研究）允许计算与 GERD 相关的关联度量，则将其纳入荟萃分析。
纳入了 18 项病例对照研究，共纳入 3206 例 IPF 患者和 9368 例对照患者，符合荟萃分析的纳入标准。荟萃分析表明 GERD 与 IPF 相关（OR，2.94[95%CI，1.95-4.42]；P 异质性<.0001）。无论数据来源（临床研究与数据库）或对照患者类型（健康志愿者、非间质性肺疾病的呼吸系统疾病患者或非 IPF 间质性肺疾病患者）如何，结果均保持一致。在元回归分析中，控制吸烟因素后，GERD 和 IPF 之间没有相关性。
GERD 和 IPF 可能相关，但这种关联很可能是混杂的，尤其是与吸烟有关。由于仅来源于病例对照研究，我们对关联估计的信心较低。
PROSPERO；编号：CRD42016053728；网址：http://www.crd.york.ac.uk/PROSPERO。
