{"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. 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":3,"journal":{"name":"ACS Applied Electronic Materials","volume":null,"pages":null},"PeriodicalIF":4.3000,"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":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Electronic Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848231219234","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"ENGINEERING, ELECTRICAL & ELECTRONIC","Score":null,"Total":0}
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Abstract
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.
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