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Review
. 2025 Jan;17(1):68-75.
doi: 10.34172/mejdd.2025.411. Epub 2025 Jan 31.

Bidirectional Association between Gastroesophageal Reflux Disease and Bipolar Disorder: A Systematic Review and Meta-analysis of Longitudinal Studies

Rahma Nurita  1 , Adit Faturohman  2 , Febrina Mustika Santoso  3 , Bianca Magdalena  4 , Muhana Fawwazy Ilyas  5   6
Affiliations
Review

Bidirectional Association between Gastroesophageal Reflux Disease and Bipolar Disorder: A Systematic Review and Meta-analysis of Longitudinal Studies

Rahma Nurita et al. Middle East J Dig Dis. 2025 Jan.

Abstract

Background: Gastroesophageal reflux disease (GERD) and bipolar disorder impose substantial global burdens on individuals and healthcare systems. Previous studies suggest a bidirectional association between GERD and bipolar disorder. By searching and reviewing the results of existing studies, this systematic review and meta-analysis aims to review the two-way relationship between GERD and bipolar disorder.

Methods: This study adhered to PRISMA Guidelines, including a comprehensive search of PubMed and Scopus for observational longitudinal studies. Quality (risk of bias) assessment employed the Newcastle-Ottawa Scale, and RevMan version 5.3 facilitated meta-analysis.

Results: Five longitudinal studies (161888 patients) revealed a significant bidirectional link between GERD and bipolar disorder. Patients with GERD had a 2.29-fold higher risk of bipolar disorder (OR=2.29 [1.64, 3.21]; P<0.001), while individuals with bipolar disorder had a 2.80-fold higher risk of GERD (OR=2.80 [1.36, 5.76]; P=0.005). This study also identified independent risk factors, including sex, age under 60 years, and alcohol consumption disorders, influencing the occurrence of bipolar disorder in patients with GERD, as well as there is an influence of the number of psychoactive drugs in the occurrence of GERD in patients with bipolar disorder.

Conclusion: These findings highlight a bidirectional relationship between GERD and bipolar disorder, emphasizing the necessity for integrated care models and personalized treatment plans. The results underscore the importance of considering both gastrointestinal and mental health aspects in managing these interconnected conditions.

Keywords: Bidirectional; Bipolar disorder; Comorbidity; Gastroesophageal reflux disease; Meta-analysis; Systematic review.

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Conflict of interest statement

Competing Interests The authors declare no conflict of interest related to this work.

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