Efficacy of drugs in chronic idiopathic constipation: a systematic review and network meta-analysis

Luthra, Pavit; Camilleri, Michael; Burr, Nicholas; Quigley, Eamonn Martin; Black, Christopher J; Ford, Alexander C

doi:10.1016/s2468-1253(19)30246-8

Cited by 96 publications

(101 citation statements)

References 64 publications

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“…Strategies were ranked according to their surface under the cumulative ranking curve value, which is comparable to the P score used in the frequentist model of our primary analyses 37. There were no differences in rankings among approaches, and therefore, for clarity, we only report the frequentist model in this paper, which is consistent with our approach for reporting previously published network meta-analyses 4041424344…”

Section: Methodsmentioning

confidence: 65%

Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis

Eusebi

Black

Howden

et al. 2019

BMJ

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ObjectiveTo determine the effectiveness of management strategies for uninvestigated dyspepsia.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, Embase Classic, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov from inception to September 2019, with no language restrictions. Conference proceedings between 2001 and 2019.Eligibility criteria for selecting studiesRandomised controlled trials that assessed the effectiveness of management strategies for uninvestigated dyspepsia in adult participants (age ≥18 years). Strategies of interest were prompt endoscopy; test for Helicobacter pylori and perform endoscopy in participants who test positive; test for H pylori and eradication treatment in those who test positive (“test and treat”); empirical acid suppression; or symptom based management. Trials reported dichotomous assessment of symptom status at final follow-up (≥12 months).ResultsThe review identified 15 eligible randomised controlled trials that comprised 6162 adult participants. Data were pooled using a random effects model. Strategies were ranked according to P score, which is the mean extent of certainty that one management strategy is better than another, averaged over all competing strategies. “Test and treat” ranked first (relative risk of remaining symptomatic 0.89, 95% confidence interval 0.78 to 1.02, P score 0.79) and prompt endoscopy ranked second, but performed similarly (0.90, 0.80 to 1.02, P score 0.71). However, no strategy was significantly less effective than “test and treat.” Participants assigned to “test and treat” were significantly less likely to receive endoscopy (relative risk v prompt endoscopy 0.23, 95% confidence interval 0.17 to 0.31, P score 0.98) than all other strategies, except symptom based management (relative risk v symptom based management 0.60, 0.30 to 1.18). Dissatisfaction with management was significantly lower with prompt endoscopy (P score 0.95) than with “test and treat” (relative risk v “test and treat” 0.67, 0.46 to 0.98), and empirical acid suppression (relative risk v empirical acid suppression 0.58, 0.37 to 0.91). Upper gastrointestinal cancer rates were low in all trials. Results remained stable in sensitivity analyses, with minimal inconsistencies between direct and indirect results. Risk of bias of individual trials was high; blinding was not possible because of the pragmatic trial design.Conclusions“Test and treat” was ranked first, although it performed similarly to prompt endoscopy and was not superior to any of the other strategies. “Test and treat” led to fewer endoscopies than all other approaches, except symptom based management. However, participants showed a preference for prompt endoscopy as a management strategy for their symptoms.Systematic review registrationPROSPERO registration number CRD42019132528.

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Section: Methodsmentioning

confidence: 65%

Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis

Eusebi

Black

Howden

et al. 2019

BMJ

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“…We did not include shamcontrolled trials of any of these interventions, due to potential differences in the sham procedure, depending on the active intervention used, meaning that these could not be treated as a single comparator, as would be the case in a network meta-analysis of placebo-controlled drug trials. [24][25][26][27] We also did not include trials that compared the above interventions against Botox therapy, as this would potentially introduce a selection bias for patients, due to the higher likelihood of the inclusion of comorbid patients, who would not be considered fit enough for either POEM or LHM, in such trials.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Mundre

Black

Mohammed

et al. 2021

The Lancet Gastroenterology & Hepatology

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“…Проносні засобице препарати з різним механізмом дії для лікування або попередження закрепів, ефективність яких підтверджена у низці досліджень та метааналізів [9,23,30]. Закрепглобальна проблема, яку населення, зазвичай, самостійно діагностує та успішно лікує [12,14,32,35].…”

Section: вступunclassified

Inconvenient topic: laxative abuse. review and clinical case

Konovalova¹,

Стопінчук²,

Krikus³

2020

Rep. of Vinnytsia Nation. Med. Univ.

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Annotation. Laxatives are drugs with different mechanism of action that are used to treat or prevent constipation. Use of laxatives to control body weight is considered a dangerous tendency, especially among young women with eating disorders. Natural or synthetic stimulant purgatives are the most commonly used for weight loss because they are cost-effective, have rapid onset of action, and available in various dosage forms. Excessive use of laxatives results in a gradual efficacy decrease causes specific damage of the gastrointestinal tract, other organs and systems. This condition is known as "laxative abuse". The purpose of this review is to summarize the available scientific data on behavioral characteristics, clinical and diagnostic criteria and tactics of treatment of laxative abuse with a clinical case description. Laxatives abuse should be suspected in case of eating disorders, clinical, laboratory, endoscopic and histological changes in the gastrointestinal tract. Treatment of laxative abuse requires gradual laxatives withdrawal, potassium replacement therapy and mandatory training in the healthy eating principles. The clinical case describes a young woman who tried to stop taking laxatives, but she started to use diuretics due to peripheral swelling. At the time of examination, the daily dose of furosemide was 600 mg (15 tablets a day). Laxative abuse is relatively common among young women and requires monitoring by physicians of various specialties.

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Efficacy of drugs in chronic idiopathic constipation: a systematic review and network meta-analysis

Abstract: This is a repository copy of Efficacy of drugs in chronic idiopathic constipation: a systematic review and network meta-analysis.

Cited by 96 publications

References 64 publications

Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis

Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis

Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Inconvenient topic: laxative abuse. review and clinical case

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