Mallah, NarmeenMay Turner, JuliaGonzález Barcala, Francisco JavierTakkouche, Bahi2022-08-192022-08-192021Pediatr Allergy Immunol. 2022;33:e13655. https://doi.org/10.1111/pai.13655http://hdl.handle.net/10347/29099Background: Gastroesophageal reflux disease (GORD) is highly prevalent and often coexists with asthma exacerbation. Divergent findings about the association between the two diseases were reported. We conducted a systematic review and meta-analysis to determine whether there exists an association between GORD and asthma. Methods: We searched MEDLINE, EMBASE, and other databases and then performed a manual search, to identify eligible studies. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using fixed- and random-effect models. We evaluated the quality of included studies, explored heterogeneity between studies, undertook subgroup analyses, assessed publication bias, and performed sensitivity analyses. Results: We identified 32 eligible studies, conducted in 14 countries and including a total of 1,612,361 patients of all ages. Overall, GORD shows a weak associationwith asthma exacerbation (OR = 1.27; 95% CI 1.18–1.35). This association was observed in cohort, case-control, and cross-sectional designs and in European as well as non-European populations. Subgroup analyses show that GORD is associated with frequent asthma exacerbations (≥3 exacerbations, OR = 1.59; 95% CI 1.13–2.24) and with exacerbations needing oral corticosteroid therapy (OR = 1.24; 95% CI 1.09–1.41). GORD pediatric patients are at higher odds of asthma exacerbation than adults. We did not detect any evidence of publication bias and the association between GORD and asthma exacerbation held in all undertaken sensitivity analyses. Conclusions: Gastroesophageal reflux disease and asthma exacerbation are weakly associatedeng© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are madehttp://creativecommons.org/licenses/by-nc-nd/4.0/Asthma exacerbationGastroesophageal reflux diseaseMeta-analysisjournal article10.1111/pai.136551399-3038open access