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.
Side effects of long-term acid suppression have increased the scholars' interest in nonpharmacologic intervention.
We summarized an umbrella review of the association between environmental factors and gastroesophageal reflux disease (GERD) and assessed their credibility.
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.
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.
We found varying levels of evidence for different environmental factors of GERD. None of them was proven to be convincing or highly recommended.
长期酸抑制的副作用增加了学者对非药物干预的兴趣。
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。
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。
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。
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。
