Comparative efficacy of pharmacological and nonpharmacological treatments for chronic idiopathic constipation in China: a Bayesian network meta-analysis

Abstract

BackgroundTo provide evidence for medical management of chronic idiopathic constipation (CIC) in China based on comparisons of all clinical practical interventions using Bayesian network meta-analysis.MethodsWe conducted a systematic literature review by searching PubMed, Embase, Cochrane Central, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database (inception to May 2019) for randomized controlled trials (RCTs) for CIC in Chinese people. Only RCTs that recruited participants aged over 18 and diagnosed with CIC by the Rome II, III or IV criteria were included. We used three outcomes to examine efficacy. The risk ratio (RR) of the responder rate, based on ≥3 spontaneous bowel movements (SBMs) per week after treatment, was the primary outcome, and the SBM count per week and the Bristol score (BS) were secondary outcomes. In addition, adverse effects (AEs) were also considered a secondary outcome to evaluate safety. We conducted Bayesian network meta-analysis with random effects, and the RR or mean difference with its 95% credible interval was calculated. In addition, we ranked all treatments via their cumulative curves (SUCRA) and assessed the quality of evidence according to the GRADE criteria.ResultsWe included a total of 42 trials (6820 participants) of 20 grouped interventions that included pharmacological and nonpharmacological treatments. For the primary outcome, fourteen interventions were significantly better than placebo, and Probiotics plus Mosapride (PB + MP) appeared superior to others (GRADE quality of evidence: Moderate to Low), followed by Prucalopride (PP) (High to Low) and Electroacupuncture (EA) (High to Low). For SBM, Compound sodium bicarbonate suppository (CSBS) appeared to be best, with an SUCRA value of 90% (High to Low). For BS, Lactulose plus Probiotics (LT + PB) was superior to others (Moderate to Low), followed by Polyethylene glycol (PEG) (High to Moderate). Although all interventions appeared non-significant when compared with placebo in terms of adverse effects, Lactulose plus Mosapride showed greater risk than others on ranking probability.ConclusionsGiven the GRADE assessment, PB + MP, PP and EA may be the priory options with moderate certainty in the quality of evidence for the primary outcome. For SBM, a CSBS may be the best option with moderate certainty in the quality of evidence. For BS, PEG may be the priory option with high certainty in the quality of evidence. However, due to a lack of high certainty in the quality of evidence, caution is needed when recommending the interventions. Because of the limitations, an increased number of trials are required for more accurate results.

Online information in Spanish on probiotics, yoghurt, kefir, kombucha, fibre and prebiotics: an analysis of the quality of information and the certainty of the evidence supporting health claims

“…Fourth, not surprisingly given its common use among healthcare professionals in gastrointestinal disorders,17 fibre was the intervention with the most health claims supported by high (reduction of cardiovascular disease risk factors)18 to moderate (protection against colorectal cancer)77 certainty of evidence. The efficacy of prebiotics for preventing constipation supported by low certainty of evidence78 appeared in a high proportion of web pages. In contrast, the more widely studied indication of prebiotics for managing hepatic encephalopathy, which showed moderate certainty of evidence,79 appeared in very few web pages (16.7%, 3/18).…”

Effect of Intradermal Thumbtack Needle for Functional Constipation: Study Protocol for a Real- World Clinical Trial

“…Research results can be more easily transformed into clinical practice and provide guidance for personalized medicine [31][32][33]. In order to balance the known and unknown prognostic factors in research, improve inter-group comparability and reduce selective bias, we adopt an individual random approach to guide the subjects into the group; the intervention does not use placebo, but use the current internationally recognized treatment of functional constipation drugs: Mosapride citrate [34]. And during the experiment, the intervention has a certain degree of exibility: professional doctors will make individualized adjustments to the patient's treatment plan.…”

Prokinetics‐safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review

“…203 A recently published Chinese Bayesian network meta-analysis showed that probiotics plus mosapride were significantly better than placebo and appeared superior to other treatments in improving bowel movements (basing on ≥3 spontaneous bowel movements per week after treatment) (moderate to low quality of evidence). 204…”