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The association between gastroesophageal reflux disease and asthma: a systematic review
  1. Benjamin Havemann (bhavemann{at}
  1. Baylor College of Medicine/Houston VAMC, United States
    1. Catherine A Henderson (catherine.henderson{at}
    1. Research Evaluation Unit, Oxford PharmaGenesis Ltd, United Kingdom
      1. Hashem B El-Serag (hasheme{at}
      1. Baylor College of Medicine/Houston VAMC, United States


        Background and aim: Gastroesophageal reflux disease (GERD) 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 GERD and asthma.

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

        Results: Twenty-eight studies met our selection criteria. The sample-size weighted average prevalence of GERD symptoms in asthma patients was 59.2%, while in controls it was 38.1%. In patients with asthma, the average prevalence of abnormal esophageal pH, esophagitis and hiatal hernia was 50.9%, 37.3% and 51.2%, respectively. The average prevalence of asthma in individuals with GERD was 4.6%, while 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 GERD symptoms in individuals with asthma and 2.3 (95% CI: 1.8-2.8), for those studies measuring the prevalence of asthma in GERD. One longitudinal study showed a significant association between a diagnosis of asthma and subsequent diagnosis of GERD (RR: 1.5; 95% CI: 1.2-1.8), while the two studies that assessed whether GERD 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 GERD and asthma, but a paucity of data on the direction of causality.

        • asthma
        • gastroesophageal reflux
        • incidence
        • prevalence
        • systematic review

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        • Competing interests: Dr C. Henderson is an employee of Oxford PharmaGenesis Ltd, which has received funding from AstraZeneca R&D M�lndal, Sweden.

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