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

  • Yuan Cheng
    Affiliations
    Beijing University of Chinese Medicine, Beijing, China

    Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
    Search for articles by this author
  • Fushun Kou
    Affiliations
    Beijing University of Chinese Medicine, Beijing, China

    Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
    Search for articles by this author
  • Jiali Liu
    Affiliations
    Beijing University of Chinese Medicine, Beijing, China

    Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
    Search for articles by this author
  • Yi Dai
    Affiliations
    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
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  • Author Footnotes
    1 Jinxiang Li and Xiaohong Li are co-senior authors for the paper, Jinxiang Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    ,
    Author Footnotes
    2 Xiaohong Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    Xiaohong Li
    Correspondence
    Corresponding author.
    Footnotes
    1 Jinxiang Li and Xiaohong Li are co-senior authors for the paper, Jinxiang Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    2 Xiaohong Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    Affiliations
    Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Jinxiang Li and Xiaohong Li are co-senior authors for the paper, Jinxiang Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    Junxiang Li
    Correspondence
    Corresponding author.
    Footnotes
    1 Jinxiang Li and Xiaohong Li are co-senior authors for the paper, Jinxiang Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    Affiliations
    Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Jinxiang Li and Xiaohong Li are co-senior authors for the paper, Jinxiang Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
    2 Xiaohong Li, Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China No.6, 1st Section, Fangxingyuan, Fangzhuang, Beijing 100078, China.
Published:December 15, 2020DOI:https://doi.org/10.1016/j.dld.2020.11.022

      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.

      Keywords

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