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Gastro-oesophageal reflux disease (GORD) is associated with significant extra-oesophageal complications including asthma but the strength and direction of this association is not clear. Havemann et al attempt to clarify this issue by systematically reviewing all published studies that examined prevalence or incidence of asthma in patients with GORD or GORD in patients with asthma. The average prevalence of asthma in patients with GORD was 4.6%, compared with 3.9% in controls (see fig). Pooling the odds ratios gave an overall ratio of 5.5 (95% CI 1.9 to 15.8) for studies reporting the prevalence of GORD symptoms in patients with asthma, compared with 2.3 (95% CI 1.8 to 2.8) for those studies measuring the prevalence of asthma in patients with 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 to 1.8). The two studies that assessed
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