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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Article info
Publication history
Published online: December 15, 2020
Accepted:
November 16,
2020
Received:
October 10,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
