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Gut. 2007 Dec;56(12):1654-64. Epub 2007 Aug 6.

The association between gastro-oesophageal reflux disease and asthma: a systematic review.

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  • 1Section of Gastroenterology, Houston Department of Veterans Affairs Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.

Abstract

BACKGROUND AND AIMS:

Gastro-oesophageal reflux disease (GORD) has been linked to a number of extra-esophageal symptoms and disorders, primarily in the respiratory tract. This systematic review aimed to provide an estimate of the strength and direction of the association between GORD and asthma.

METHODS:

Studies that assessed the prevalence or incidence of GORD in individuals with asthma, or of asthma in individuals with GORD, were identified in Medline and EMBASE via a systematic search strategy.

RESULTS:

Twenty-eight studies met the selection criteria. The sample size weighted average prevalence of GORD symptoms in asthma patients was 59.2%, whereas in controls it was 38.1%. In patients with asthma, the average prevalence of abnormal oesophageal pH, oesophagitis and hiatal hernia was 50.9%, 37.3% and 51.2%, respectively. The average prevalence of asthma in individuals with GORD was 4.6%, whereas in controls it was 3.9%. Pooling the odds ratios gave an overall ratio of 5.5 (95% CI 1.9-15.8) for studies reporting the prevalence of GORD symptoms in individuals with asthma, and 2.3 (95% CI 1.8-2.8) for those studies measuring the prevalence of asthma in GORD. One longitudinal study showed a significant association between a diagnosis of asthma and a subsequent diagnosis of GORD (relative risk 1.5; 95% CI 1.2-1.8), whereas the two studies that assessed whether GORD precedes asthma gave inconsistent results. The severity-response relationship was examined in only nine studies, with inconsistent findings.

CONCLUSIONS:

This systematic review indicates that there is a significant association between GORD and asthma, but a paucity of data on the direction of causality.

Comment in

PMID:
17682001
[PubMed - indexed for MEDLINE]
PMCID:
PMC2095717
Free PMC Article

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