Abstract：
OBJECTIVE: Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings. Several treatments have been reported in the literature with variable ulcer healing rates. This study aimed to evaluate the efficacy of different treatments for SRUS.
METHODS: A systematic review and network meta-analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle-Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study\'s primary outcome was to estimate the rate of patients with ulcer healing.
RESULTS: A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57-0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14).
CONCLUSIONS: Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422).
METHODS: A systematic review and network meta-analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle-Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study\'s primary outcome was to estimate the rate of patients with ulcer healing.
RESULTS: A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57-0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14).
CONCLUSIONS: Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422).
摘要：
目的：孤立性直肠溃疡综合征（SRUS）是一种良性且鲜为人知且治疗复杂的疾病。典型的症状包括排便时紧张，直肠出血,重弹,粘液分泌，肛门疼痛和不完全疏散感。诊断基于特征性临床症状和内窥镜/组织学发现。文献中已经报道了几种具有可变溃疡愈合率的治疗方法。本研究旨在评估不同治疗方法对SRUS的疗效。
方法：根据PRISMA指南进行系统评价和网络荟萃分析。英语学习,包括法语和西班牙语。用其他语言写的论文被排除在外。其他排除标准是审查，病例报告或临床系列纳入少于五名患者，研究重复，没有感兴趣的临床数据，也没有文章。2000年1月至2024年3月，使用以下数据库进行了系统的文献检索：PubMed/MEDLINE，Cochrane中央控制试验登记册,Cochrane系统评价数据库，还有Scopus.在适当的情况下，使用纽卡斯尔-渥太华量表或Jadad量表评估研究的偏见。收集并严格评估治疗类型及其对SRUS治疗的疗效。该研究的主要结果是评估患者的溃疡愈合率。
结果：在最终的荟萃分析中，共分析了22项研究，其中911例（男性361例，女性550例）被诊断为SRUS。综合疗效估计显示，手术显示溃疡愈合率最高（70.5%；95%CI0.57-0.83）。手术治疗溃疡优于药物治疗和生物反馈（OR0.09和OR0.14）。
结论：孤立性直肠溃疡综合征是一个具有挑战性的临床治疗实体。据报道，手术方法取得了良好的结果，提示其在医疗和生物反馈治疗难治性病例中的积极作用。需要在同质人群中进行进一步的研究来评估手术在这种情况下的疗效。（PROSPERO注册号CRD42022331422）。
方法：根据PRISMA指南进行系统评价和网络荟萃分析。英语学习,包括法语和西班牙语。用其他语言写的论文被排除在外。其他排除标准是审查，病例报告或临床系列纳入少于五名患者，研究重复，没有感兴趣的临床数据，也没有文章。2000年1月至2024年3月，使用以下数据库进行了系统的文献检索：PubMed/MEDLINE，Cochrane中央控制试验登记册,Cochrane系统评价数据库，还有Scopus.在适当的情况下，使用纽卡斯尔-渥太华量表或Jadad量表评估研究的偏见。收集并严格评估治疗类型及其对SRUS治疗的疗效。该研究的主要结果是评估患者的溃疡愈合率。
结果：在最终的荟萃分析中，共分析了22项研究，其中911例（男性361例，女性550例）被诊断为SRUS。综合疗效估计显示，手术显示溃疡愈合率最高（70.5%；95%CI0.57-0.83）。手术治疗溃疡优于药物治疗和生物反馈（OR0.09和OR0.14）。
结论：孤立性直肠溃疡综合征是一个具有挑战性的临床治疗实体。据报道，手术方法取得了良好的结果，提示其在医疗和生物反馈治疗难治性病例中的积极作用。需要在同质人群中进行进一步的研究来评估手术在这种情况下的疗效。（PROSPERO注册号CRD42022331422）。
