{"title":"食管裂孔疝与巴雷特食管之间的关系：最新荟萃分析与试验序列分析。","authors":"Shaoze Ma, Zhenhua Tong, Yong He, Yiyan Zhang, Xiaozhong Guo, Xingshun Qi","doi":"10.1177/17562848231219234","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE.</p><p><strong>Objectives: </strong>The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE.</p><p><strong>Design: </strong>A meta-analysis with trial sequential analysis.</p><p><strong>Data sources and methods: </strong>The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane <i>Q</i> test and <i>I</i>² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.</p><p><strong>Results: </strong>Forty-seven studies with 131,517 participants were included. Based on the unadjusted data from 47 studies, hiatal hernia was significantly associated with an increased risk of any length BE (OR = 3.91, 95% CI = 3.31-4.62, <i>p</i> < 0.001). The heterogeneity was significant (<i>I</i>² = 77%; <i>p</i> < 0.001) and the definition of controls (<i>p</i> = 0.014) might be a potential contributor to heterogeneity. Based on the adjusted data from 14 studies, this positive association remained (aOR = 3.26, 95% CI = 2.44-4.35, <i>p</i> < 0.001). The heterogeneity was also significant (<i>I</i>² = 65%; <i>p</i> < 0.001). Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE (LSBE) (OR = 10.01, 95% CI = 4.16-24.06, <i>p</i> < 0.001). The heterogeneity was significant (<i>I</i>² = 78%; <i>p</i> < 0.001). Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE (OR = 2.76, 95% CI = 2.05-3.71, <i>p</i> < 0.001). The heterogeneity was not significant (<i>I</i>² = 30%; <i>p</i> = 0.201).</p><p><strong>Conclusion: </strong>Hiatal hernia should be a significant risk factor for BE, especially LSBE.</p><p><strong>Registration: </strong>PROSPERO registration number CRD42022367376.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10771746/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association between hiatal hernia and Barrett's esophagus: an updated meta-analysis with trial sequential analysis.\",\"authors\":\"Shaoze Ma, Zhenhua Tong, Yong He, Yiyan Zhang, Xiaozhong Guo, Xingshun Qi\",\"doi\":\"10.1177/17562848231219234\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE.</p><p><strong>Objectives: </strong>The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE.</p><p><strong>Design: </strong>A meta-analysis with trial sequential analysis.</p><p><strong>Data sources and methods: </strong>The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane <i>Q</i> test and <i>I</i>² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.</p><p><strong>Results: </strong>Forty-seven studies with 131,517 participants were included. 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引用次数: 0
摘要
背景：巴雷特食管（BE）是食管腺癌的前兆。认识与巴雷特食管相关的风险因素至关重要：本荟萃分析旨在系统评估食管裂孔疝与食管癌风险的相关性：数据来源和方法：检索了PubMed、EMBASE和Cochrane图书馆数据库。在对未调整数据和混杂因素调整数据进行综合估算后，分别计算了汇总的几率比（ORs）和调整后的几率比（aORs）及其95%置信区间（CIs）。异质性采用 Cochrane Q 检验和 I² 统计量进行量化。为了探究异质性的来源，还采用了分组分析、元回归分析和排除敏感性分析：共纳入 47 项研究，131,517 名参与者。根据 47 项研究的未调整数据，食管裂孔疝与任何长度的 BE 风险增加显著相关（OR = 3.91，95% CI = 3.31-4.62，p I² = 77%；p p = 0.014），这可能是导致异质性的一个潜在因素。根据 14 项研究的调整数据，这种正相关性依然存在（aOR = 3.26，95% CI = 2.44-4.35，p I² = 65%；p p I² = 78%；p p I² = 30%；p = 0.201）：结论：食管裂孔疝应该是BE，尤其是LSBE的重要风险因素：PROSPERO注册号：CRD42022367376。
Association between hiatal hernia and Barrett's esophagus: an updated meta-analysis with trial sequential analysis.
Background: Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE.
Objectives: The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE.
Design: A meta-analysis with trial sequential analysis.
Data sources and methods: The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane Q test and I² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.
Results: Forty-seven studies with 131,517 participants were included. Based on the unadjusted data from 47 studies, hiatal hernia was significantly associated with an increased risk of any length BE (OR = 3.91, 95% CI = 3.31-4.62, p < 0.001). The heterogeneity was significant (I² = 77%; p < 0.001) and the definition of controls (p = 0.014) might be a potential contributor to heterogeneity. Based on the adjusted data from 14 studies, this positive association remained (aOR = 3.26, 95% CI = 2.44-4.35, p < 0.001). The heterogeneity was also significant (I² = 65%; p < 0.001). Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE (LSBE) (OR = 10.01, 95% CI = 4.16-24.06, p < 0.001). The heterogeneity was significant (I² = 78%; p < 0.001). Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE (OR = 2.76, 95% CI = 2.05-3.71, p < 0.001). The heterogeneity was not significant (I² = 30%; p = 0.201).
Conclusion: Hiatal hernia should be a significant risk factor for BE, especially LSBE.
Registration: PROSPERO registration number CRD42022367376.
期刊介绍：
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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