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Scandinavian Journal of Gastroenterology Jul 2024Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton-pump inhibitors (PPIs) are recommended as a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton-pump inhibitors (PPIs) are recommended as a first-line therapy to treat GERD. Recently, the potassium-competitive acid inhibitors have been increasingly in use in clinical practice. We aimed to evaluate the efficacy and safety of P-CABs in GERD.
METHODS
We searched PubMed, the Cochrane Library, EMBASE and Web Of Science for publications regarding randomized controlled trials comparing potassium-competitive acid inhibitors to PPI monotherapy or Placebo with respect to efficacy and safety in GERD (until April 2023). The primary outcome was an absence or global symptom improvement and the incidence of adverse events in GERD. The quality of the included literature was assessed using the bias assessment tool recommended in the Cochrane Systematic Assessor's Handbook 5.1.0. We use RevMan 5.3 software for Meta-analysis, sensitivity analysis and publication bias analysis.
RESULTS
Of the 991 screened studies, 14 studies including 4868 participants were analyzed. The ORs for the healing rates of GERD with P-CABs versus PPI/Placebo were 2.10 (95% confidence interval [CI] 1.53-2.88), additionally, 1.09 (95% CI 1.05-1.14), 1.03 (95% CI 1.00-1.06) and 1.03 (95% CI 0.99-1.06) in Weeks 2, 4, and 8, respectively. The effectiveness rate of the experimental group was significantly higher than that of the control group (RR 1.73; 95% CI 1.27-2.36). The overall OR of Incidence of adverse events with P-CABs versus PPI/Placebo was 1.08 (95% CI 0.88-1.12). Overall, the risk of bias was low to some concerns. Furthermore, sensitivity analyses confirmed the robustness of the study's conclusion.
CONCLUSIONS
Our findings suggest that potassium-competitive acid inhibitors is non-inferior to PPIs as therapy for patients with GERD. The safety outcomes for potassium-competitive acid inhibitors are similar to those for PPIs.
Topics: Gastroesophageal Reflux; Humans; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38741565
DOI: 10.1080/00365521.2024.2349638 -
Alimentary Pharmacology & Therapeutics Dec 2011BACKGROUND A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM To evaluate... (Review)
Review
BACKGROUND A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM To evaluate whether there is a causal relationship between GERD and different ILDs. METHODS We conducted a systematic search of literature published between 1980 and 2010. After a review by two independent authors, each study was assigned an evidence-based rating according to a standard scoring system. RESULTS We identified 319 publications and 22 of them met the entry criteria. Of those, the relationship between GERD and idiopathic pulmonary fibrosis (IPF) was investigated in 14 articles, pulmonary involvement in systemic sclerosis (SSc) in six articles and pulmonary involvement in mixed connective tissue disease (MCTD) in two articles. We found the prevalence of GERD and/or oesophageal dysmotility to be higher in patients with different types of ILD as compared with those without ILD [Evidence B]. Among patients with IPF, 67-76% demonstrated abnormal oesophageal acid exposure off PPI treatment. No relationship was demonstrated between severity of GERD and severity of IPF [Evidence B]. Data are scant on outcomes of antireflux treatment in patients with IPF. There is a correlation between the severity of ILD and the degree of oesophageal motor impairment in patients with SSc and MCTD [Evidence B]. CONCLUSIONS Based on the currently available data, a causal relationship between GERD and idiopathic pulmonary fibrosis cannot be established. There is scant evidence about antireflux therapy in idiopathic pulmonary fibrosis patients. There may be an association between lung and oesophageal involvement in systemic sclerosis and mixed connective tissue disease, but a causal relationship cannot be established.
Topics: Gastroesophageal Reflux; Humans; Lung Diseases, Interstitial; Prevalence; Risk Factors
PubMed: 21999527
DOI: 10.1111/j.1365-2036.2011.04870.x -
Pediatrics Apr 2010The relationship between gastroesophageal reflux disease (GERD) and asthma in children has been investigated; however, the nature of the association (if any) between... (Review)
Review
CONTEXT
The relationship between gastroesophageal reflux disease (GERD) and asthma in children has been investigated; however, the nature of the association (if any) between these 2 conditions is unclear.
OBJECTIVE
We performed a systematic review of the literature to examine the association between GERD and asthma in children.
METHODS
A search of the medical literature was conducted by using PubMed and Embase (1966 through December 2008). Full-length articles in English that described at least 20 subjects younger than 18 years were included if they reported the prevalence of GERD (symptoms, pH studies, endoscopy/histology) in individuals with asthma or the prevalence of asthma in individuals with GERD. We calculated pooled odds ratios from studies that examined control groups, and we pooled prevalence estimates from all studies.
RESULTS
A total of 20 articles that described 5706 patients fulfilled the inclusion and exclusion criteria. Seventeen studies used objective methods for documenting reflux (eg, pH probe, contrast imaging, impedance, esophagogastroduodenoscopy), 2 studies relied on symptom-based questionnaires, and 1 study used diagnostic codes. Most studies (n = 19) examined the prevalence of GERD in 3726 individuals with asthma and reported highly variable estimates (19.3%-80.0%) and a pooled average of 22.8% with GERD symptoms, 62.9% of 789 patients with abnormal esophageal pH, and 34.8% of 89 patients with esophagitis. Only 5 studies included controls and enrolled 1314 case-patients with asthma and 2434 controls without asthma. The average prevalence of GERD was 22.0% in asthma cases and 4.8% in controls (pooled odds ratio: 5.6 [95% confidence interval: 4.3-6.9]).
CONCLUSIONS
There is a possible association between GERD and asthma in pediatric patients seen with asthma in referral settings. However, because of methodologic limitations of existing studies, the paucity of population-based studies, and a lack of longitudinal studies, several aspects of this association are unclear.
Topics: Age Factors; Asthma; Child; Gastroesophageal Reflux; Humans; Risk Factors
PubMed: 20351005
DOI: 10.1542/peds.2009-2382 -
Surgical Innovation Dec 2023Laparoscopic Nissen fundoplication (LNF) is the most common standard technique worldwidely for Gastroesophageal reflux disease (GERD). Another type of fundoplication,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Laparoscopic Nissen fundoplication (LNF) is the most common standard technique worldwidely for Gastroesophageal reflux disease (GERD). Another type of fundoplication, laparoscopic Toupet fundoplication (LTF), intends to reduce incidence of postoperative complications. A systematic review and meta-analysis are required on short- and long-term outcomes based on randomized controlled trials (RCTs) between LNF and LTF.
METHODS
We searched databases including PubMed, Cochrane, Embase, and Web of Knowledge for RCTs comparing LNF and LTF. Outcomes included postoperative reflux recurrence, postoperative heartburn, dysphagia and postoperative chest pain, inability to belch, gas bloating, satisfaction with intervention, postoperative esophagitis, postoperative DeMeester scores, operating time (min), in-hospital complications, postoperative use of proton pump inhibitors, reoperation rate, postoperative lower oesophageal sphincter (LOS) pressure (mmHg). We assessed data using risk ratios and weighted mean differences in meta-analyses.
RESULTS
Eight eligible RCTs comparing LNF (n = 605) and LTF (n = 607) were identified. There were no significant differences between the LNF and LTF in terms of postoperative reflux recurrence, postoperative heartburn, postoperative chest pain, satisfaction with intervention, reoperation rate in short and long term, in-hospital complications, esophagitis in short term, and gas bloating, postoperative DeMeester scores, postoperative use of proton pump inhibitors, reoperation rate in long term. LTF had lower LOS pressure (mmHg), fewer postoperative dysphagia and inability to belch in short and long term and gas bloating in short term compared to LNF.
CONCLUSION
LTF were equally effective at controlling reflux symptoms and improving the quality of life, but with lower rate of complications compared to LNF. We concluded that LTF surgical treatment was superior for over 16 years old patients with typical symptoms of GERD and without upper abdominal surgical history upon high-level evidence of evidence-based medicine.
Topics: Humans; Adolescent; Fundoplication; Deglutition Disorders; Heartburn; Proton Pump Inhibitors; Treatment Outcome; Gastroesophageal Reflux; Laparoscopy; Esophagitis; Pain, Postoperative; Chest Pain
PubMed: 36998190
DOI: 10.1177/15533506231165829 -
American Journal of Otolaryngology 2020Gastroesophageal reflux disease (GERD) has been associated with head and neck cancer (HNC), including laryngeal and pharyngeal anatomical sites. A systematic review and... (Meta-Analysis)
Meta-Analysis
PURPOSE
Gastroesophageal reflux disease (GERD) has been associated with head and neck cancer (HNC), including laryngeal and pharyngeal anatomical sites. A systematic review and meta-analysis was performed to examine these associations.
METHODS
Articles were retrieved from the Medline, Web of Science, Scopus, and Embase databases using keywords "gastroesophageal reflux disease", "laryngopharyngeal reflux", "head and neck cancer", and associated variants. Inclusion criteria were English language publications, human subjects, and controlled studies with described development of head and neck cancer among individuals with GERD. 13 studies with a total of 39,824 patients were included.
RESULTS
Overall, presence of GERD was associated with an increased risk of developing HNC (OR = 1.86, 95% Confidence Interval [CI] = 1.27-2.74). This association remained significant with laryngeal cancers (OR = 1.95, 95% CI = 1.33-2.86), but not pharyngeal cancers (OR = 1.56, 95% CI = 0.86-2.83). Subgroup analyses of hypopharyngeal (OR = 2.26, 95% CI = 0.67-7.68) and oropharyngeal subsites (OR = 1.39, 95% CI = 0.51-3.84) were not statistically significant. Meta-analysis of studies that objectively assessed reflux, such as pH monitor placement, showed statistical significance (OR = 2.81, 95% CI = 1.36-5.81), while studies that used subjective reporting or chart review of GERD were not significant (OR = 1.46, 95% CI = 0.89-2.40). Association between H. pylori infection and head and neck cancers was not statistically significant (OR = 2.66, 95% CI = 0.59-11.97).
CONCLUSION
A diagnosis of GERD is associated with a later diagnosis of HNC, but this association is not significant for pharyngeal cancers. Associations of GERD with HNC may be specific to laryngeal cancers.
LEVEL OF EVIDENCE
Systematic review and meta-analysis of case control studies (3a).
Topics: Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Head and Neck Neoplasms; Humans; Laryngeal Neoplasms; Male; Pharyngeal Neoplasms; Risk
PubMed: 32841763
DOI: 10.1016/j.amjoto.2020.102653 -
Neurogastroenterology and Motility Dec 2023The use of a symptom-based gastroesophageal reflux disease (GERD) questionnaire (GerdQ) for GERD diagnosis has gained interest due to its greater efficacy and ease of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of a symptom-based gastroesophageal reflux disease (GERD) questionnaire (GerdQ) for GERD diagnosis has gained interest due to its greater efficacy and ease of use than other available questionnaires. However, different guidelines have given inconsistent recommendations regarding using GerdQ as a diagnostic test. This meta-analysis summarized the diagnostic accuracy of GerdQ for diagnosing GERD.
METHODS
Studies published up to April 12, 2023, and indexed in MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library were searched. Diagnostic test accuracy studies comparing GerdQ with upper endoscopy and/or pH-metry for GERD diagnosis in adult patients with symptoms suggestive of GERD were included. The study quality was assessed using the QUADAS-2 tool. Meta-analysis using bivariate (Reitsma) analysis was done to summarize the overall sensitivity, specificity, likelihood ratios (LRs), and diagnostic odds ratio (DOR). The summary receiver operating characteristics (SROC) curve was visualized, and the area under the ROC (AUC) was calculated.
KEY RESULTS
A total of 13 studies with 11,166 participants were included in the meta-analysis. The pooled sensitivity, specificity, positive LR, negative LR, and DOR for GerdQ (cut-off value of ≥8) were 66.9% (95% CI 56.4%-73.1%), 65.2% (95% CI 56.4%-73.1%), 1.93 (95% CI 1.55-2.42), 0.51 (95% CI 0.38-0.66), and 3.89 (95% CI 2.44-5.89), respectively. The overall AUC from the SROC was 0.705. The subgroup analysis showed similar pooled sensitivity, specificity, and DOR between Asian and non-Asian studies.
CONCLUSIONS & INFERENCES
GerdQ had moderate sensitivity and specificity for GERD diagnosis. GerdQ can still be recommended as a diagnostic tool for GERD, especially when the PPI test is unavailable or contraindicated.
Topics: Adult; Humans; Gastroesophageal Reflux; Surveys and Questionnaires; Sensitivity and Specificity; ROC Curve; Endoscopy, Gastrointestinal
PubMed: 37278156
DOI: 10.1111/nmo.14619 -
Clinical Gastroenterology and... Aug 2012This systematic review assesses findings of endoscopic surveys in the general population with regard to gastroesophageal reflux disease (GERD). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
This systematic review assesses findings of endoscopic surveys in the general population with regard to gastroesophageal reflux disease (GERD).
METHODS
Systematic searches were conducted in PubMed and EMBASE. Authors were contacted for additional, unpublished data.
RESULTS
Data on 61,281 individuals were included from 3 general population studies (Kalixanda study [Sweden], Loiano-Monghidoro study [Italy], SILC study [China]) and 8 health-check studies (Japan, n = 1; China, n = 1; Taiwan, n = 4; Korea, n = 2). The prevalence of reflux esophagitis was 15.5% (Kalixanda), 11.8% (Loiano-Monghidoro), and 6.4% (SILC); it ranged from 3.4% to 8.5% in health-check studies in Japan, China, and Korea (n = 4), but was higher (mean, 15.6%; range, 9.0%-24.6%; n = 4) in Taiwan. Hiatus hernia prevalence was 23.9% (Kalixanda), 43.0% (Loiano-Monghidoro), and 0.7% (SILC), and 0.8%-19.5% in health-check studies (n = 7). For endoscopically suspected esophageal metaplasia (ESEM), the prevalence was 10.3% (Kalixanda), 3.6% (Loiano-Monghidoro), and 1.8% (SILC), and 0.0%-3.4% in health-check studies (n = 4). The prevalence of reflux esophagitis among individuals without symptom-defined GERD was 12.1% (Kalixanda), 8.6% (Loiano-Monghidoro), 6.1% (SILC), and 1.6%-22.8% (health-check studies; n = 6). For individuals without symptom-defined GERD, the prevalence of ESEM was 9.4% (Kalixanda), 2.8% (Loiano-Monghidoro), and 1.8% (SILC).
CONCLUSIONS
The prevalence of reflux esophagitis is higher in Sweden and Italy than in China, Korea, and Japan, but is within the range reported in Taiwan. Hiatus hernia and ESEM are generally more prevalent in Europe than in Asia. A considerable proportion of individuals without symptom-defined GERD has reflux esophagitis or ESEM.
Topics: Esophagoscopy; Esophagus; Gastroesophageal Reflux; Humans
PubMed: 22401904
DOI: 10.1016/j.cgh.2012.02.028 -
Journal of Dentistry Oct 2022To perform systematic review and quantitative analysis of the literature on the association between gastro-oesophageal reflux disease (GERD) and dental erosion in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To perform systematic review and quantitative analysis of the literature on the association between gastro-oesophageal reflux disease (GERD) and dental erosion in children.
METHODS
Databases were searched for randomised controlled trials, cohort studies, cross-sectional surveys and case-control studies that evaluated the association between GERD and dental erosion in children aged 1-18 years, without limitations on the language or year of publication. Data were pooled in random effects models. Data sources included Embase, MEDLINE, Web of Science, Trip Pro, Cochrane Library, the International Clinical Trials Registry Platform, ClinicaTrials.gov, Open Grey, Proquest Dissertations and Thesis and Google Scholar from inception to June 9, 2022.
RESULTS
Thirteen studies were included, of which twelve were used for meta-analysis. There were strong associations between GERD and enamel erosion with the subject as unit (odds ratio 4.46; 95% confidence interval (CI) 1.93-10.30; n = 6774); dentine erosion with the subject as unit (odds ratio 13.39; 95% CI 4.17-42.94; n = 371); enamel erosion with the tooth as unit (odds ratio 3.29; 95% CI 1.36-7.95; n = 4637); as well as dentine erosion with the tooth as unit (odds ratio 5.91; 95% CI, 2.35-14.86; n = 4637). In cohort studies, GERD was associated with a higher risk of enamel erosion with the subject as a unit (relative risk 1.88, 95% CI 1.22-2.92; n = 1411).
CONCLUSIONS
Gastro-oesophageal reflux disease is associated with dental erosion in children. The heterogeneity of GERD definition should be considered when interpreting the present work.
CLINICAL SIGNIFICANCE
There is a positive association between GERD and dental erosion in children. Dentists should emphasise timely detection and management of the underlying factors of dental erosion in GERD. Future studies should define paediatric GERD according to a universal guideline to better enhance patient care.
Topics: Case-Control Studies; Child; Cross-Sectional Studies; Gastroesophageal Reflux; Humans; Odds Ratio
PubMed: 35917996
DOI: 10.1016/j.jdent.2022.104247 -
Clinical Gastroenterology and... Jun 2019Gastric reflux may lead to chronic mucosal inflammation and contribute to development of laryngeal malignancies, although there is controversy over this association. We... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Gastric reflux may lead to chronic mucosal inflammation and contribute to development of laryngeal malignancies, although there is controversy over this association. We performed a systematic review and meta-analysis to assess this relationship and determine the risk of laryngeal malignancy in patients with reflux disease.
METHODS
We performed a systematic review and meta-analysis, searching MEDLINE, EMBASE, and Web of Science databases from 1900 through April 9, 2018, for observational studies of adults reporting associations between gastroesophageal reflux disease (GERD) and/or laryngopharyngeal reflux and the risk of having or developing laryngeal malignancies. An itemized assessment of the risk of bias was conducted for each study that met inclusion criteria. The meta-analysis was performed using the Mantel-Haenszel method with random effects to account for heterogeneity. We performed subgroup analyses to determine the effect of reflux type, study design, diagnostic method, and confounding variables on the overall risk.
RESULTS
Of the 957 studies that were identified during systematic review, 18 case-control studies met the criteria for analysis. Our meta-analysis showed that reflux disease significantly increased the risk of laryngeal malignancy (odds ratio, 2.47; 95% CI, 1.90-3.21; P < .00001; I = 94%). This association remained when controlling for patient smoking and drinking (odds ratio, 2.07; 95% CI, 1.26-3.41). There was no statistically significant difference in risk of laryngeal malignancies between patients with GERD vs laryngopharyngeal reflux (P = .44).
CONCLUSIONS
In a systematic review and meta-analysis, we found a significant association between reflux disease and the presence of laryngeal malignancy. Prospective studies should be performed to examine this relationship.
Topics: Alcohol Drinking; Gastroesophageal Reflux; Global Health; Humans; Laryngeal Neoplasms; Laryngopharyngeal Reflux; Morbidity; Risk Assessment; Risk Factors; Smoking
PubMed: 30366155
DOI: 10.1016/j.cgh.2018.10.028 -
Surgical Endoscopy Aug 2023Endoscopic plication offers an alternative to surgical fundoplication for treatment of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Endoscopic plication offers an alternative to surgical fundoplication for treatment of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis evaluate outcomes following endoscopic plication compared to laparoscopic fundoplication.
METHODS AND PROCEDURES
Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in September 2022. Study followed PRISMA guidelines. Studies comparing endoscopic plication to laparoscopic fundoplication with n > 5 were included. Primary outcome was PPI cessation, with secondary outcomes including complications, procedure duration, length of stay, change in lower esophageal sphincter (LES) tone, and DeMeester score.
RESULTS
We reviewed 1544 studies, with five included comparing 105 (46.1%) patients receiving endoscopic plication (ENDO) to 123 (53.9%) undergoing laparoscopic fundoplication (LAP). Average patient age was 47.6 years, with those undergoing plication being younger (46.4 ENDO vs 48.5 LAP). BMI (26.6 kg/m ENDO vs 26.2 kg/m LAP), and proportion of females (42.9% ENDO vs 37.4% LAP) were similar. Patients undergoing laparoscopic procedures had worse baseline LES pressure (12.8 mmHg ENDO vs 9.0 mmHg LAP) and lower preoperative DeMeester scores (34.6 ENDO vs. 34.1 LAP). The primary outcome demonstrated that 89.2% of patients undergoing laparoscopic fundoplication discontinued PPI compared to 69.4% for those receiving plication. Meta-analysis revealed that plication had significantly reduced odds of PPI discontinuation (OR 0.27, studies = 3, 95% CI 0.12 to 0.64, P = 0.003, I = 0%). Secondary outcomes demonstrated that odds of complications (OR 1.46, studies = 4, 95% CI 0.34 to 6.32, P = 0.62, I = 0%), length of stay (MD - 1.37, studies = 3, 95% CI - 3.48 to 0.73, P = 0.20, I = 94%), and procedure durations were similar (MD 0.78, studies = 3, 95% CI - 39.70 to 41.26, P = 0.97, I = 98%).
CONCLUSIONS
This is the first meta-analysis comparing endoscopic plication to laparoscopic fundoplication. Results demonstrate greater likelihood of PPI discontinuation with laparoscopic fundoplication with similar post-procedural risk.
Topics: Female; Humans; Middle Aged; Fundoplication; Treatment Outcome; Gastroesophageal Reflux; Esophageal Sphincter, Lower; Laparoscopy
PubMed: 37407715
DOI: 10.1007/s00464-023-10202-x