Association of Coffee Intake with Risk of Gastroesophageal Reflux Disease and Complications: A Systematic Review and Meta-Analysis

INTRODUCTION: Patients with gastroesophageal reflux disease (GERD) are commonly instructed to reduce coffee intake. However, previous studies evaluating the effects of coffee on GERD yielded conflicting results. We aimed to perform a comprehensive systematic review and meta-analysis to assess the association between coffee use and risk of GERD and its complications.

METHODS: A protocolized search strategy was developed for PubMed, EMBASE, and Web of Science databases in accordance with preferred reporting items for systematic reviews and meta-analyses and meta-analyses of observational studies in epidemiology guidelines. Measured outcomes for GERD were compared between coffee drinkers and nondrinkers. Dichotomous events between unmatched groups were used to calculate pooled proportions with rates estimated using random effects models and effect size. Heterogeneity was assessed with I2 statistics and publication bias by funnel plot asymmetry and Egger regression.

RESULTS: A total of 40 studies encompassing 122,074 patients were included (85,400 coffee drinkers vs 36,674 nondrinkers). GERD was more common among coffee users than nonusers (34.9% [CI: 28.5-41.8] vs 30.7% [CI: 25.2-36.7]; OR: 1.18 [CI: 1.03-1.36; I 2 = 89.38]). There was no significant association between coffee intake and Barrett's esophagus (22.1% [CI: 12.8-35.4] users vs 17.6% [CI:5.5-43.8] nonusers; OR:1.13 [CI:0.79-1.61; I 2 = 55.5]). There was no evidence of publication bias based on funnel plot and Egger regression testing ( P > 0.05 for all analyses).

DISCUSSION: Coffee use was associated with a small, statistically significant increased rate of GERD, but not Barrett's. The magnitude of this effect, however, is of unclear clinical significance. The role of routine avoidance/reduction of coffee intake as universal lifestyle modification for GERD needs further evaluation.