Association between hiatal hernia and Barrett’s esophagus: an updated meta-analysis with trial sequential analysis

作者：Shaoze Ma, Zhenhua Tong, Yong He, Yiyan Zhang, Xiaozhong Guo, Xingshun Qi · 发表于：Therapeutic Advances in Gastroenterology · 年份：2024 · DOI：10.1177/17562848231219234 · 被引用次数：10 · 研究领域：Esophageal Cancer Research and Treatment、Gastroesophageal reflux and treatments、Esophageal and GI Pathology

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 asso...