Beijing University of Chinese Medicine, Beijing, China; Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
Department of Pharmacotherapy and Oriental Medicine, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan; School of Life Science, Beijing University of Chinese Medicine, Beijing 100029, China.
Dig Liver Dis. 2021 May;53(5):566-573. doi: 10.1016/j.dld.2020.11.022. Epub 2020 Dec 16.
BACKGROUND: Side effects of long-term acid suppression have increased the scholars' interest in nonpharmacologic intervention. AIMS: We summarized an umbrella review of the association between environmental factors and gastroesophageal reflux disease (GERD) and assessed their credibility. METHODS: We appraised systematic reviews and meta-analyses. For each meta-analysis, we considered the effect size, 95% confidence interval, the heterogeneity, small-study effects, P-value for excess significance and largest study significant, then we graded the evidence according to Assessment of Multiple Systematic Reviews and the GRADE assessment. RESULTS: 23 publications met the inclusion criteria (13 meta-analyses and 10 systematic reviews), which evaluated 24 environmental factors. Among observational studies, we identified 7 risk factors: overweight/obesity [GERD/erosive esophagitis (EE)/GERD symptom], central adiposity [EE], smoking [GERD], alcohol [GERD/EE/non-erosive reflux disease (NERD)], NSAID [GERD], coffee [EE], Helicobacter pylori eradication [EE], and 1 protective factor: physical activity [GERD], this was based on a suggestive evidence of credibility. Across intervention studies, we identified 1 risk factor-Helicobacter pylori eradication [GERD] and 1 protective factor-breathing exercises [GERD], evidence for both was low grade. CONCLUSIONS: We found varying levels of evidence for different environmental factors of GERD. None of them was proven to be convincing or highly recommended.
背景:长期酸抑制的副作用增加了学者对非药物干预的兴趣。
目的:我们总结了环境因素与胃食管反流病(GERD)之间关联的伞式评价,并评估了其可信度。
方法:我们评估了系统评价和荟萃分析。对于每一项荟萃分析,我们考虑了效应大小、95%置信区间、异质性、小样本效应、过度显著性 P 值和最大研究显著性,然后根据评估多项系统评价和 GRADE 评估对证据进行分级。
结果:23 篇文献符合纳入标准(13 项荟萃分析和 10 项系统评价),评估了 24 个环境因素。在观察性研究中,我们确定了 7 个危险因素:超重/肥胖[胃食管反流病/糜烂性食管炎(EE)/胃食管反流病症状]、中心性肥胖[EE]、吸烟[GERD]、饮酒[GERD/EE/非糜烂性反流病(NERD)]、非甾体抗炎药[GERD]、咖啡[EE]、幽门螺杆菌根除[EE],以及 1 个保护因素:体力活动[GERD],这是基于可信度的暗示证据。在干预性研究中,我们确定了 1 个危险因素-幽门螺杆菌根除[GERD]和 1 个保护因素-呼吸练习[GERD],这两者的证据等级都较低。
结论:我们发现不同的环境因素与 GERD 之间存在不同程度的证据。没有一个因素被证明是令人信服或高度推荐的。
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