目的:多种药物治疗可用于治疗肠易激综合征(IBS),并提出了大量证据。然而,证据的强度和可信度尚未得到全面评估。我们旨在回顾IBS药物治疗的系统评价和荟萃分析,并评估研究结果的可信度。
方法:我们搜索了MEDLINE,Embase,和Cochrane图书馆从开始到2019年9月进行系统评价,评估IBS药物治疗的有效性。我们总结了相对比率(RR),评估证据的可信度,并将证据分类为令人信服,高度暗示性,暗示,和软弱。
结果:我们纳入了11项系统评价,包括40项荟萃分析(330项随机对照试验和86,459名参与者),评估了10种治疗类别和2种药物。所纳入的荟萃分析报告,大多数药物治疗明显优于安慰剂。5-羟色胺(5-HT)3拮抗剂的证据(RR=1.56,95CI:1.43-1.71),抗痉挛药(RR=1.19,95CI:1.02-1.39),阿洛司琼(RR=1.46,95CI:1.26-1.71)高度提示缓解整体IBS症状。发现5-HT4激动剂(RR=1.26,95CI:1.19-1.34)和鸟苷酸环化酶C(GCC)激动剂(RR=1.73,95CI:1.54-1.95)为提高应答率提供了令人信服的证据。5-HT3拮抗剂(RR=1.32,95CI:1.26-1.38)为缓解腹痛提供了令人信服的证据。
结论:5-HT3拮抗剂的证据,5-HT4激动剂和GCC激动剂,抗痉挛药,阿洛司琼提示治疗IBS。然而,由于随机化方法存在偏倚的风险,GCC的结果应谨慎解释.
OBJECTIVE: Multiple pharmacologic treatments are available for the management of irritable bowel syndrome (IBS), and a large body of evidence has been presented. However, the strength and credibility of the evidence have not been comprehensively evaluated. We aimed to
review the systematic reviews and meta- analyses of pharmacologic treatments for IBS and evaluate the credibility of the findings.
METHODS: We searched MEDLINE, Embase, and Cochrane library from inception to September 2019 for systematic reviews evaluating the effectiveness of pharmacologic treatments for IBS. We summarized relative ratios (RR), evaluated the credibility of the evidence and classified the evidence into convincing, highly suggestive, suggestive, and weak.
RESULTS: We included 11 systematic reviews with 40 meta-analyses (330 randomized controlled trials and 86,459 participants) assessing 10 treatment categories and 2 drugs. Most of the pharmacologic treatments were significantly superior over placebo as reported by the included meta-analyses. The evidence for 5-hydroxytryptamine (5-HT)3 antagonists (RR=1.56, 95%CI: 1.43-1.71), antispasmodics (RR=1.19, 95%CI: 1.02-1.39), and alosetron (RR=1.46, 95%CI: 1.26-1.71) were highly suggestive for relieving global IBS symptoms. 5-HT4 agonists (RR= 1.26, 95%CI: 1.19-1.34) and guanylate cyclase-C (GCC) agonists (RR=1.73, 95%CI: 1.54-1.95) were found to give convincing evidence for the improvement of the responder rate. 5-HT3 antagonists (RR=1.32, 95%CI: 1.26-1.38) offered convincing evidence for relieving abdominal pain.
CONCLUSIONS: Evidence for 5-HT3 antagonists, 5-HT4 agonists and GCC agonists, antispasmodics, and alosetron were suggestive for the treatment of IBS. However, owing to the risk of bias in randomization methods, the results for GCC should be interpreted with caution.