Gastroesophageal disease risk and inhalational exposure a systematic review and meta-analysis

Environmental exposure-associated diseases, particularly in the context of rising air pollution and inhalant use, are an active area of research. Our group is dedicated to the study of exposure-related inflammation and its downstream adverse health effects. While many studies have focused on the impact of environmental exposures on respiratory sequelae, there is growing evidence of the involvement of other systems including gastrointestinal. This systematic review provides updates on the associations between inhalation exposures and the risk of upper gastrointestinal disease. Primary search identified N = 764 PubMed and N = 1,036 Web of Science studies, of which N = 111 met eligibility criteria. Our systematic review and meta-analysis showed significant associations between inhalational exposures (cigarette smoking, waterpipe smoking, and particulate matter) and upper gastrointestinal diseases. The pooled estimate of esophagitis was 1.32 (95% confidence interval [CI], 1.06-1.65; I²:86%), gastroesophageal reflux disease was 1.71 (1.14-2.55; I²:94%), peptic ulcer disease was 1.21 (1.03-1.43; I²:93%), esophageal cancer was 1.83 (1.54-2.18; I²:73%), and gastric cancer was 1.71 (1.39-2.10; I²:73%). However, the pooled estimate for Barrett's esophagus was 0.93 (0.65-1.34; I²:76%), indicating no significant association. Sensitivity analyses confirmed these findings. Risk of bias assessment showed most studies were of good quality. Our findings emphasize the impact of inhalational exposures on gastrointestinal disease risk, highlighting the need for further research to better understand this interaction and targeted public health interventions.