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The International Journal of Medical Science and Health Research

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The International Journal of Medical Science and Health Research, published by International Medical Journal Corp. Ltd. is dedicated to providing physicians with the best research and important information in the world of medical research and science and to present the information in a format that is understandable and clinically useful. Committed to publishing multidisciplinary research that spans the entire spectrum of healthcare and medicine access, The American Journal of Medical Science and Health Research aims at an international audience of pharmacists, clinicians, medical ethicists, regulators, and researchers, providing an online forum for the rapid dissemination of recent research and perspectives in this area.

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Articles 577 Documents

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Evaluating The Effectiveness of Contraceptive Counseling in Adolescents : A Systematic Review I Komang Sutama Arta; Agus Indra Yudhistira Diva Putra
The International Journal of Medical Science and Health Research Vol. 42 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/3ber3b54

Introduction: Adolescent unintended pregnancy remains a global public health challenge with significant medical and social consequences. Contraceptive counseling interventions vary widely in content, delivery, and effectiveness. This systematic review evaluates the effectiveness of contraceptive counseling interventions for adolescents on contraceptive use and pregnancy outcomes. Methods: A systematic review was conducted following PRISMA guidelines. We screened studies based on predefined criteria: target population (adolescents aged 10-19 years), intervention type (contraceptive counseling delivered by healthcare providers, trained counselors, or peer educators), effectiveness outcomes (contraceptive knowledge, attitudes, uptake, adherence, or reproductive health outcomes), and study design (randomized controlled trials, quasi-experimental studies, or controlled before-and-after studies). Data extraction included study characteristics, population details, intervention components, comparator groups, and quantitative outcomes. Synthesis focused on patterns of effectiveness across intervention types, settings, and populations. Results: Eighty studies were included, representing diverse populations across multiple countries with sample sizes ranging from 50 to over 105,000 participants. Immediate postpartum contraceptive counseling significantly increased long-acting reversible contraception (LARC) use (OR 3.78, 95% CI 2.18-6.57). Motivational interviewing interventions improved effective contraception use (OR 2.04, 95% CI 1.47-2.83) and LARC initiation (OR 3.99, 95% CI 1.36-11.68). Sustained, intensive programs like Prime Time demonstrated persistent effects at 24 months on consistent hormonal contraception use (adjusted RR 1.30) and condom use (RR 1.57). Quality initiatives removing access barriers increased LARC use by 90% and reduced teenage pregnancy rates by 36% (from 2.2% to 1.4%, p<0.0001). Peer education showed variable effectiveness, succeeding when addressing social norms but failing when reduced to information transmission. Technology-based interventions demonstrated mixed results. Discussion: Effective interventions share common characteristics: delivery during critical transition periods (particularly postpartum), sustained contact over time, motivational interviewing approaches addressing ambivalence, removal of access barriers through same-visit provision, and system-level provider training. Setting-specific barriers fundamentally shape success, with school-based health centers providing on-site contraception achieving higher uptake than referral-dependent models. Adolescents demonstrate strong preferences for implants over intrauterine devices, suggesting counseling should address method-specific concerns. Implementation challenges in real-world replications highlight the difficulty of maintaining program fidelity at scale. Conclusion: Contraceptive counseling effectively improves adolescent contraceptive use and reduces pregnancy rates when interventions are appropriately timed, sustained, and combined with structural supports. Recommendations include implementing counseling during postpartum periods, utilizing motivational interviewing techniques, ensuring same-day contraceptive access, providing system-level provider training, and addressing population-specific barriers. Future research should focus on implementation strategies that maintain effectiveness when scaling interventions.

BOTULINUM TOXIN TYPE A (BoNT-A) FOR NEUROPATIC CANCER PAIN : A SYSTEMATIC REVIEW Christy; Alvionita Muntholib
The International Journal of Medical Science and Health Research Vol. 42 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6977z217

Background: Neuropathic cancer pain (NCP) is a highly prevalent and debilitating condition affecting 30–50% of cancer patients undergoing treatment, with rates rising to 70–90% in advanced stages. Conventional pharmacotherapy, including opioids and adjuvants, often provides inadequate relief or causes significant adverse effects, highlighting the need for alternative therapeutic strategies. Botulinum Toxin Type A (BoNT-A) has emerged as a potential analgesic agent with a unique mechanism of action. Objective: To systematically evaluate the effectiveness and safety of BoNT-A as a therapeutic option for neuropathic cancer pain. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Four databases (PubMed, ScienceDirect, Cochrane Library, ProQuest) were searched for randomized controlled trials (RCTs), pilot studies, and prospective cohort studies published between January 2015 and January 2025. Inclusion criteria were: studies assessing BoNT-A for NCP, quantitative pain outcomes, English language, and sample size ≥10 patients. Results: Six studies (five RCTs and one prospective open-label study) involving 151 cancer patients were included. All studies reported statistically significant pain reduction following BoNT-A injection, with pain scores decreasing by 30–50% in most trials. Functional outcomes, such as arm mobility and quality of life, also improved. BoNT-A demonstrated a favorable safety profile, with only mild, transient local side effects. No serious systemic adverse events were reported. Discussion: BoNT-A reduces NCP through multiple mechanisms: inhibition of acetylcholine, substance P, CGRP, and glutamate release; modulation of TRPV1 receptors; and central antinociceptive effects. Evidence supports its role as an effective adjunct or alternative to opioids, particularly in post-surgical and post-radiotherapy pain. Conclusion: BoNT-A is effective and safe for managing neuropathic cancer pain. Further large-scale RCTs are needed to establish optimal dosing, long-term efficacy, and comparative effectiveness against standard therapies.

Effectiveness of PrEP (Pre-Exposure Prophylaxis) Integrated into Venereology Services : A Systematic Review Jerymia Bangun; Wynna Manami; Zahra Astriantani Sulih
The International Journal of Medical Science and Health Research Vol. 42 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/k3jga391

Background: Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but optimal service delivery models remain unclear. Integrating PrEP into venereology and sexual health services offers a promising approach to reach at-risk populations, yet real-world effectiveness, uptake, retention, and implementation outcomes vary substantially across settings. Methods: This systematic review synthesized 80 studies examining PrEP integration into venereology, sexual health, and STI clinics across North America, Europe, sub-Saharan Africa, Latin America, and Asia-Pacific. We included randomized controlled trials, cohort studies, demonstration projects, and implementation research reporting outcomes on PrEP uptake, adherence, retention, HIV incidence, STI outcomes, and service delivery innovations. Results: Integrated PrEP services demonstrated high HIV prevention effectiveness, with incidence rates ranging from 0.13 to 0.24 per 100 person-years and risk reductions of 86–90% in large trials (1,3,14). However, uptake varied substantially: 57.1% in England (1), 14.9% among US women (6), 40.6% in Kenyan family planning clinics (12), and 98.1% in a Paris hospital (13). Retention declined steeply over time, from 57% at 1 month to 23% at 12 months in Kenyan public clinics (14,15), but reached 85.9% at 12 months in a Thai community program (16). Self-reported adherence significantly overestimated biomarker-confirmed adherence, especially among people who inject drugs (77% vs 3% with protective levels) (57). STI incidence was high (68.1/100 person-years in England) but concentrated in a minority of users (24% accounted for 79.5% of diagnoses) (1). Telehealth, peer navigation, and dynamic choice models improved outcomes. Long-acting injectable PrEP showed 60.9% full adherence in early implementation (66). Discussion: Integration effectiveness depends critically on population-specific barriers, implementation support intensity, and retention strategies. Settings with comprehensive support (monthly counseling, SMS reminders, community delivery) achieved far better retention than basic integration into existing infrastructure. Self-reported adherence is unreliable, particularly in marginalized populations. STI increases often reflect intensified surveillance rather than true risk compensation. Conclusion: Integrating PrEP into venereology services is effective and feasible, but success requires tailored, multi-component implementation strategies. Retention, not just initiation, is the critical intervention target. Biomarker-validated adherence monitoring and enhanced support for younger, socioeconomically deprived users are essential.

A Analysis Study of Diagnostic Quality and Accuracy of Post Mortem Magnetic Resonance Imaging as An Alternative to Autopsy in The Diagnosis of Death : A Comprehensive Systematic Review Assyifa Amalia Amin; Prijo Sidipratomo
The International Journal of Medical Science and Health Research Vol. 42 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/je5qp594

Background: Virtual autopsy, or VA, is a non-invasive method that supports traditional autopsy (CA) by utilizing cutting-edge technologies including computed tomography, magnetic resonance imaging, and X-rays. In cases of pathological post-mortems (PMs) where cultural or religious restrictions limit the use of CA, VA can be employed. Comprehending the correlation between diagnostic quality and the precision of postmortem magnetic resonance imaging as a substitute for traditional autopsy might be advantageous in formulating strategies and mitigating the difficulty of precisely determining the cause of death in certain cases. Methods: Following PRISMA 2020 guidelines, this systematic review concentrated on full-text English literature published between 2014 and 2024. Editorials and review articles that appeared in the same journal as the submission were not accepted without a DOI. Several websites, including ScienceDirect, PubMed, and SagePub, were utilized to gather the literature. Result: Based on credible sources such as Science Direct, SagePub, and PubMed, the analysis looked at more than 1,500 articles. After it was decided that eight publications needed to be looked at further, the entire article was examined in greater detail. Conclusion: PMMR is a high-sensitivity diagnostic tool that provides detailed information about structural abnormalities and fetal disease processes. It is crucial for neuroradiological examination in perinatal post-mortem settings and demonstrates high diagnostic accuracy. Combining PMCT and PMMR has demonstrated high sensitivity in identifying skeletal injuries and cardiomyopathies, but requires specialized training to minimize over-interpretation of non-specific findings.

The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review Bagus Wanda H; Gina Fauziah; Dahlia Winda N
The International Journal of Medical Science and Health Research Vol. 43 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8ya98g06

Background: The global rise in cesarean section (CS) rates has raised concern about subsequent pregnancy complications, particularly placenta accreta spectrum (PAS). This review synthesizes evidence on the relationship between prior CS history and PAS incidence. Methods: A systematic review of 80 studies (RCT, etc) was conducted. Studies required clear PAS diagnostic criteria, comparison groups, and reported association measures between CS history and PAS. Results: Prior CS is consistently associated with increased PAS risk. Klar & Michels reported summary OR 1.96 (95%CI 1.41–2.74) for any prior CS. Keag et al. found OR 2.95 (95%CI 1.32–6.60) for CS vs vaginal delivery. A strong dose-response exists: Silver et al. data show accreta rates of 0.2% (1 CS), 0.3% (2 CS), 0.6% (3 CS), 2.1% (4 CS), 2.3% (5 CS), 6.7% (≥6 CS) in all-comers. With concurrent placenta previa, rates rise dramatically: 3.3% (1 CS), 11.1% (2 CS), 40.0% (3 CS), 61.0% (4 CS), 67.0% (≥5 CS). Iacovelli et al. reported OR 2.6 (1.6–4.4) for 2 prior CS and OR 5.4 (1.7–17.4) for 3 prior CS. Bonanni et al. cited Nordic ORs of 6.6 (4.4–9.8), 17.4 (9.0–31.4), and 55.9 (25.0–110.3) for 1,2,≥3 CS respectively. PAS without previa is less associated with CS (OR 0.15, 95%CI 0.06–0.37, p<0.001) and more with IVF and curettage. Classical CS carries higher accreta risk than low-transverse CS. Isthmocele is an intermediate risk factor. PAS leads to severe morbidity: postpartum hemorrhage 80%, hysterectomy 43.3%, transfusion 23.3%. Discussion: The CS-PAS association is robust, dose-dependent, and mechanistically explained by defective decidualization at the uterine scar. The interaction with placenta previa creates the highest-risk group. Temporal trends show rising PAS incidence alongside CS rates. Conclusion: Prior CS significantly increases PAS risk in a dose-response manner, especially with coexisting placenta previa. Women with multiple prior CS and previa warrant specialized antenatal surveillance and multidisciplinary delivery planning.

The Relationship Between Uric Acid Levels and The Progression of End-Stage Renal Disease : A Systematic Review Lilis Haryani
The International Journal of Medical Science and Health Research Vol. 43 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6ea68v56

Introduction: Elevated serum uric acid (SUA) is associated with chronic kidney disease (CKD) progression, but large trials of urate-lowering therapy (ULT) show conflicting results. This systematic review synthesizes evidence on the relationship between SUA levels and end-stage renal disease (ESRD) progression. Methods: We screened longitudinal studies (RCTs, etc) examining SUA as a predictor or intervention for CKD progression to ESRD (eGFR <15 mL/min/1.73m², dialysis, or transplantation). Data extraction focused on SUA measurement, ESRD outcomes, confounders, and ULT effects. Results: Among 80 included sources (total >3.4 million patients), observational studies consistently showed that hyperuricemia predicts ESRD (HR 1.53–2.84) and rapid eGFR decline (OR 1.38–3.77) with dose-response relationships (1,2,5,18). The association was nonlinear: hazard of kidney failure increased sharply above 11 mg/dL, while mortality showed a U-shaped relationship with nadir at 5 mg/dL (6). Large RCTs (FEATHER, CKD-FIX, PERL) found no significant benefit of ULT on eGFR slope, but meta-analyses of smaller trials reported modest eGFR preservation (mean difference 1.81–4.10 mL/min/1.73m²) (1,8,9). Achieving SUA <6 mg/dL, not merely initiating ULT, was associated with 37–63% fewer renal events (11,12). Effect modification by baseline CKD stage, proteinuria, sex, and disease etiology was prominent. Discussion: The observational-evidence and RCT-evidence discordance is explained by low progression rates in control arms, insufficient target SUA achievement, and population heterogeneity. ULT appears most beneficial in early CKD (stages 1–3), rapidly progressive disease, and when SUA target <6 mg/dL is reached. In advanced CKD, very low SUA may be harmful. Conclusion: Elevated SUA is a robust independent risk factor for CKD progression, but ULT benefits are conditional on patient selection and target attainment. Future trials should enroll high-risk, hyperuricemic patients with progressive disease and titrate to SUA <6 mg/dL.

A Comprehensive Systematic Review of Social Determinants in Maternal Mortality Rates in Developing Countries Maria Ayu Florenza Monar; Prilly Parrhesia Edong Rumissing
The International Journal of Medical Science and Health Research Vol. 43 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/h17j2h20

Introduction: Maternal mortality remains a critical public health challenge in developing countries, where 94% of global maternal deaths occur. Social determinants—including education, poverty, geographic access, gender inequality, and health system quality—drive persistent disparities. This systematic review synthesizes evidence on these determinants to identify priority interventions. Methods: We screened 80 studies (RCT, etc) from Sub-Saharan Africa, South Asia, Southeast Asia, Latin America, and the Middle East. Inclusion criteria required quantitative data on social determinants and maternal mortality outcomes in World Bank-defined developing countries. Data extraction focused on seven domains: study setting, social determinants, maternal mortality measurement, associations, interventions, barriers, and key findings. Results: Low maternal education showed the strongest individual-level association, with relative risks of 3.2 (95% CI: 1.5–6.9) for no formal education versus secondary education [1]. Female literacy rate was the strongest national-level predictor in the Eastern Mediterranean (β = −1.045, p < 0.01), exceeding GDP per capita [2]. Household poverty was associated with hazard ratios of 3.92 (95% CI: 1.01–15.3) in rural South Africa [4] and 94.8% of maternal deaths in Pakistan occurred among poor women [60]. Geographic barriers dominated Sub-Saharan Africa and rural Nepal, with transportation delays reported in 84.6% of African studies [6]. The three-delays model showed continental patterning: Delay 1 (decision-making) dominates Asia, Delay 2 (transport/geography) dominates Africa, and Delay 3 (quality of care) dominates Latin America [7]. Health system failures contributed to 80.8% of deaths in African facilities [6]. Community-based interventions including birth preparedness (≥30% coverage reduced mortality by 53%, RR = 0.47; 95% CI: 0.26–0.87) and emergency transport loans showed effectiveness [15,41]. Discussion: Education, poverty, and geographic access are consistently the most powerful determinants across all settings, but their relative importance shifts with economic development. In low-income rural settings, geographic distance and transport are binding constraints; in middle-income urbanizing contexts, health system quality and governance become paramount. Indonesia-specific evidence is limited but suggests high institutional delivery coverage (91.8% of deaths occurred in facilities in Bali) has shifted the bottleneck from access to quality of care [14]. The absence of Papua-specific studies represents a critical evidence gap. Conclusion: Reducing maternal mortality in developing countries requires multi-level interventions that simultaneously address education, poverty, transport, and health system quality. Priority actions include: (1) sustaining female secondary education, (2) scaling community-based transport financing, (3) improving facility readiness for emergency obstetric care, and (4) targeting interventions to the predominant delay pattern in each region. Research is urgently needed in remote Indonesian regions such as Papua.

EFFECT OF VITAMIN D SUPPLEMENTATION ON CLINICAL OUTCOMES IN CRITICALLY ILL ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS WITH SUBGROUP ANALYSIS BY BASELINE VITAMIN D STATUS Inri Eunike Sigarlaki; Salmawati Maryati
The International Journal of Medical Science and Health Research Vol. 43 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/t7raxk67

Introduction: Vitamin D deficiency is highly prevalent among critically ill patients and has been associated with increased morbidity and mortality. Despite strong biological plausibility and supportive observational data, randomized controlled trials (RCTs) evaluating vitamin D supplementation in this population have yielded inconsistent results. This study aimed to systematically evaluate the effect of vitamin D supplementation on clinical outcomes, particularly mortality, in critically ill adult patients. Methods: A systematic review and meta-analysis of RCTs was conducted in accordance with PRISMA guidelines. Electronic databases (PubMed, Scopus, ScienceDirect, and Cochrane) were searched for studies published between January 2015 and December 2025. Eligible studies included RCTs involving adult critically ill ICU patients receiving vitamin D supplementation compared with placebo. The primary outcome was all-cause mortality. Secondary outcomes included ICU length of stay, hospital length of stay, and duration of mechanical ventilation. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Five RCTs comprising 1,736 critically ill patients (871 in the intervention group and 865 in the control group) were included. Vitamin D supplementation was associated with a no statistically significant difference in mortality between groups (RR 0.74; 95% CI 0.53–1.05; p = 0.09). Substantial heterogeneity was observed (I² = 71.1%, p = 0.008), with a wide prediction interval (0.28–1.96). Larger trials demonstrated neutral effects, whereas smaller studies reported more pronounced benefits, suggesting a potential small-study effect. Secondary outcomes were inconsistently reported and showed variable findings, precluding quantitative synthesis. Discussion: The findings suggest that vitamin D supplementation does not provide a consistent mortality benefit in unselected critically ill populations. The observed heterogeneity, variation in study design, and potential influence of small-study effects contribute to the uncertainty of the overall estimate. While biological plausibility and subgroup signals indicate possible benefit in selected patients, current evidence remains insufficient to support routine use for mortality reduction. Conclusion: Vitamin D supplementation in critically ill adult patients was associated with a non-significant trend toward reduced mortality, with substantial heterogeneity across studies. Routine use of high-dose vitamin D for mortality reduction cannot be recommended based on current evidence. Further large-scale, well-designed trials focusing on clearly defined subgroups are needed.

Relationship between Dietary Oxalate Intake and Urinary Oxalate Excretion in Patients with Nephrolithiasis : A Systematic Review Yuni Agnes Lubis; Dini Miori; Heri Setiawan
The International Journal of Medical Science and Health Research Vol. 43 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/9j3aaq57

Introduction: Nephrolithiasis, particularly calcium oxalate (CaOx) stones, is strongly influenced by urinary oxalate excretion. Dietary oxalate intake is a modifiable risk factor, but its quantitative relationship with urinary oxalate and the comparative effectiveness of dietary strategies remain debated. This systematic review evaluates the positive significant relationship between dietary oxalate intake and urinary oxalate excretion in nephrolithiasis patients. Methods: A systematic search was performed for human studies assessing both dietary oxalate intake and urinary oxalate excretion in nephrolithiasis patients. Data on study design, dietary assessment, urinary oxalate measurement, intervention effects, and confounding factors were extracted. Results: The foundational quantitative estimate shows that for every 100 mg of dietary oxalate consumed, urinary oxalate increases by approximately 2.7 mg (1). Dietary oxalate accounts for 25-53% of total urinary oxalate (2). Low-oxalate dietary interventions significantly reduce urinary oxalate by 20-35% in idiopathic hyperoxaluria (3-5). In the prospective randomized trial by Gupta et al., low-oxalate diet reduced urinary oxalate by 31.1% (P=0.007) (3). Aziz et al. reported a 48.9% reduction (23). Normal-calcium, low-protein, low-salt diet reduced oxaluria by 78 µmol/day (95% CI 26.48-129.52) and stone recurrence (RR 0.77) (30). Dietary counseling significantly lowered urinary oxalate from 46.28 to 32.56 mg/day (P<0.0001) (6). Mediterranean diet adherence was associated with 13-41% lower stone risk (pooled HR 0.72, 95% CI 0.59-0.87) despite higher urinary oxalate (16). Calcium intake with meals significantly reduces urinary oxalate (7,25), while ascorbic acid supplementation increases urinary oxalate by 20-33% (12,21). Enteric hyperoxaluria shows attenuated response to dietary restriction alone (8,9). Discussion: A consistent positive association exists between dietary oxalate and urinary oxalate, with significant reductions from low-oxalate diets. However, multi-component dietary patterns (DASH, Mediterranean) may provide superior overall lithogenic risk reduction by improving citrate, magnesium, and urine volume. Conclusion: Dietary oxalate restriction significantly reduces urinary oxalate in idiopathic hyperoxaluria. Meal-concurrent calcium intake and comprehensive dietary patterns are more effective than oxalate restriction alone. Enteric hyperoxaluria requires additional therapies.

Relationship Between GERD Comorbidity and The Severity of Nocturnal Asthma Symptoms: A Systematic Review Zaid Hidayah; Ammar Hidayah; Islamiah Nur Insani; Fathin Hidayah
The International Journal of Medical Science and Health Research Vol. 43 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/63sx0515

Background: Gastroesophageal reflux disease (GERD) and asthma are common comorbid conditions, but the specific impact of GERD on the severity of nocturnal asthma symptoms remains debated. Methods: This systematic review synthesized evidence from 80 studies, including randomized controlled trials (RCTs), etc. We focused on the prevalence of GERD in asthma, the strength of association with nocturnal symptoms, pathophysiological mechanisms, and treatment outcomes. Results: The weighted average prevalence of GERD symptoms in asthma patients was 59.2% vs. 38.1% in non-asthmatics (p<0.001). Nocturnal GERD (nGER) was independently associated with new asthma onset (OR 2.3, 95% CI 1.1–4.9) and incident wheeze (OR 2.18, 95% CI 1.60–2.98). Bidirectional epidemiological data showed GERD increased asthma risk (HR 1.46, 95% CI 1.42–1.49) and asthma increased GERD risk (HR 1.36, 95% CI 1.33–1.39). Mechanistically, esophageal acid perfusion induced bronchoconstriction via vagal reflex and microaspiration. Surgical antireflux therapy reduced nocturnal exacerbations (74.9% improvement vs. 9.1% with medical therapy, p<0.001). However, proton pump inhibitors (PPIs) showed no significant improvement in morning PEF (WMD 8.68 L/min, 95% CI -2.02 to 19.37, p=0.11) in unselected asthmatics. Obesity and obstructive sleep apnea (OSA) were major confounders; in obese asthmatics, OSA rather than GERD drove nocturnal symptoms. Discussion: The apparent paradox between strong epidemiological associations and weak PPI treatment effects is explained by non-acid reflux mechanisms, patient heterogeneity, and colinear comorbidities.Conclusion: Nocturnal GERD significantly increases asthma severity and incidence, but PPI therapy benefits only symptomatic, confirmed GERD subgroups. Surgical fundoplication and CPAP (in OSA+GERD) improve nocturnal asthma outcomes.

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Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia

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