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系统评估胃食管反流病的环境因素:系统评价和荟萃分析的伞状综述。

Systematic assessment of environmental factors for gastroesophageal reflux disease: An umbrella review of systematic reviews and meta-analyses.

机构信息

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.

出版信息

Dig Liver Dis. 2021 May;53(5):566-573. doi: 10.1016/j.dld.2020.11.022. Epub 2020 Dec 16.


DOI:10.1016/j.dld.2020.11.022
PMID:33339748
Abstract

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.

摘要

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。

相似文献

[1]
Systematic assessment of environmental factors for gastroesophageal reflux disease: An umbrella review of systematic reviews and meta-analyses.

Dig Liver Dis. 2021-5

[2]
Effects of Helicobacter pylori eradication on gastroesophageal reflux disease.

Helicobacter. 2011-8

[3]
Association between Helicobacter pylori and Barrett's esophagus, erosive esophagitis, and gastroesophageal reflux symptoms.

Clin Gastroenterol Hepatol. 2013-8-27

[4]
[Clinical characteristics of gastroesophageal reflux diseases and association with Helicobacter pylori infection].

Korean J Gastroenterol. 2006-5

[5]
The Effect of Helicobacter pylori Eradication in Patients with Gastroesophageal Reflux Disease: A Meta-Analysis of Randomized Controlled Studies.

Dig Dis. 2020-5-12

[6]
[Helicobacter pylori eradication and gastroesophageal reflux disease: a Meta-analysis].

Zhonghua Nei Ke Za Zhi. 2016-9-1

[7]
Effect of Helicobacter pylori eradication on development of erosive esophagitis and gastroesophageal reflux disease symptoms: a post hoc analysis of eight double blind prospective studies.

Am J Gastroenterol. 2002-12

[8]
Effect of Helicobacter pylori treatment on gastroesophageal reflux disease (GERD): meta-analysis of randomized controlled trials.

Scand J Gastroenterol. 2012-2

[9]
Alcohol Consumption and the Risk of Gastroesophageal Reflux Disease: A Systematic Review and Meta-analysis.

Alcohol Alcohol. 2019-1-1

[10]
Background factors of reflux esophagitis and non-erosive reflux disease: a cross-sectional study of 10,837 subjects in Japan.

PLoS One. 2013-7-26

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[9]
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