Objectives To assess the effectiveness and safety of additional bedtime H2-receptor antagonists (H2RAs) in suppressing nocturnal gastric acid breakthrough (NAB). Methods We identified eligible trials by searching The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMbase and CINAHL. We handsearched the data from the proceedings of correlated conferences, eight kinds of important Chinese journals and references of all included trials. All randomized controlled trials evaluating H2RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. Results Only two randomized crossover studies including 32 participants met the inclusion criteria. Because the design, dosage and duration of the treatment were different between the studies, it was impossible to conduct Meta-analysis. There was no consistent conclusion between the two included studies in evaluating H2RAs for the control of NAB. Conclusion We can not conclude any implications for practice at this stage. Appropriately designed large-scale randomized controlled trials with long-term follow-up are needed to decide the effects of additional bedtime H2RAs in suppressing NAB.
Objective To evaluate the difference of oral sodium phosphate (NaP) and polyethylene glycol-electrolyte lavage solution (PEG-ELS) in the aspects of cleansing efficacy, tolerance, and safety in clinical practice, so as to provide evidence for clinical practice. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed according the handbook of the Cochrane Collaboration. RCTs were identified from The Cochrane Library(Issue1,2004) MEDLINE(1980-2004), EMBASE(1984-2004),and CBM(1978-2004).Handsearching was also performed .RCTs comparing the two methods were selected .Tow reviewers independently assessed the quality of included trials and extracted data independently .Results Eighteen trials involving 3668 patients were included .Sub-group analysis was performed. Nap tablet had higher rate of adequate cleansing quality (RR1.08,95%CI1.02 to 1.05,p=0.01).Two-day ,divided-dose oral Nap was superior in the rate of adequate cleansing quality (RR1.27,95%CI1.06 to 1.52,p=0.009). .The. rate of adequate cleansing quality in right colon of Nap was lower than PEG-ELS(RR0.79,95%CI 0.64 to 0.98,p=0.03).The rate of abdominal cramps (RR 0.84,95%CI 0.72 to 0.99),the rate of abdominal fullness (RR 0.48,95%CI 0.26 to 0.89),the rate of nausea (RR 0.65,95%CI 0.56 to 0.76)and the percentage of patients who didn’t finished their prescribed regimen (RR 0.23,95%CI0.14 to 0.36)in Nap group were lower (plt;0.05).Conclusions Compared with PEG-ELS,Nap is superior in cleansing efficacy , patients’ tolerance ,safety and economy . It is possible to promote the use of Nap in clinical practice in China .
Objective To provide best available evidence for clinical practice and further research planning on IBS treatment, we reviewed systematically all the randomised controlled trials on calcium channel blockers for irritable bowel syndrome. The primary objective was to determine whether there was enough evidence that calcium channel blocker was effective and safe in the treatment of patients with IBS. Method Searches were performed in Trials Register of the Cochrane Complementary Medicine Field, data from the pharmaceutical company were also retrieved. In addition we searched the electronic bibliographic databases: Cochrane Controlled Trials Register, Medline, Embase, Chinese Biological Medical Database (CBM-disc). We handsearched some important Chinese journals. Two reviewers included studies, assessed the quality of studies and extracted data independently. Disagreement was resolved by discussion or the third party when needed. The following primary outcomes were assessed: ① Effective rate at the end of experiment, ② Improvmemnt in abodeminal pain and distention, ③ Adverse events. Results 49 potentially eligible trials were identified, of which 9 trials (831 patients) were included. 8 trials were waiting for assessment. The mean percentage of patients with global improvement was 48.9% in control group and 75% in the calcium channel blockers group. In favour of calcium group with a mean OR 4.54, 95%CI (2.38, 8.66). Conclusions Selective calcium channel blockers might be effective and safe in the treatment of patients with IBS.Because the methodological quality of all included studies was poor,further high-quality randomised controlled trials should be performed.
Objective To systematically evaluate the effectiveness and safety of itopride vs. mosapride in patients with functional dyspepsia, so as to provide references for clinical practice. Methods According to strict inclusive and exclusive criteria, relevant randomized controlled trials (RCTs) on itopride vs. mosapride for functional dyspepsia were searched in CENTRAL, Medline, Embase, ISI, OVID, CBM, VIP, WanFang Data and CNKI from the date of their establishment to November 2011. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Meta-analyses were conducted using Revman 5.1 software. Results A total of 4 trials involving 363 patients were included and data were coped with meta-analysis. a) About the improvement of overall symptoms: itopride was not superior to mosapride, with no significant difference (OR=1.62, 95%CI 0.53 to 4.93, P=0.4); b) About the improvement of single symptom: itopride was not superior to mosapride in improving single symptom as follows: postprandial fullness, upper abdominal distention, poor appetite, and upper abdominal pain, with no significant difference; and c) About the incidence of adverse events: itopride was similar to mosapride (OR=0.63, 95%CI 0.31 to 1.29, P=0.21). Conclusion Current evidence shows that itopride is similar to mosapride in effectively improving overall symptoms and single symptom, and it has fewer side effects than mosapride does. Due to the low quality of most included studies, more strictly-designed and large-scale RCTs are needed to provide reasonable proofs for clinic.
Objective To assess the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention of colorectal neoplasia. Methods A systematic review of all relevant randomized controlled trials and quasi-randomized controlled trials of NSAIDs for prevention of colorectal neoplasms was performed by using The Cochrane Collaboration recommended methods. Results Nine trials were included and assessed. There was sufficient evidence for aspirin to prevent the development of colorectal adenomas compared with placebo in three trials of high quality and large sample size with relative risk (RR) 0.81, 95% confidence interval (CI) 0.72 to 0.91 and P=0.000 5 . No adequate evidence supported aspirin in the prevention of development of colorectal cancer (RR 0.97, 95% CI 0.79 to 1.20, P= 0.79). However, there was no evidence to support sulindac and celecoxib curing or preventing colorectal adenomas or familial adenomatous polyposis (RR 0.71, 95% CI 0.49 to 1.03, P= 0.07 and RR 0.90, 95% CI 0.76 to 1.07, P=0.23). No evidence on the dose of NSAIDs was used for prevention of colorectal adenomas at present. No significant difference was seen in the number of adverse events between patients taking NSAIDs and those taking placebo (P=0.9). Conclusions Aspirin may prevent the development of colorectal adenomas and may avoid polypectomy for 1 in every 10 to 18 persons but we don’t know whether aspirin can be substituted for endoscopically removed colorectal polyps. However, the true clinical benefit for prevention of colorectal neoplasia of NSAIDs should be considered.
Objective To evaluate the effectiveness and safety of pancreatic duct stenting in prevention of post-ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis for patients at high risk. Methods We searched the Controlled Trials Database of the Cochrane Upper Gastro-Intestinal and Pancreatic Disease Group (Issue 1, 2004), Cochrane Controlled Trials Register (Issue 1, 2004), MEDLINE (1966-2004, 4), EMBASE (1985-2004, 4), CBMdisk (1970-2004, 4), and the Chinese Cochrane Center Database of Clinical Trials; we handsearched 8 Chinese journals, and references of eligible studies were also screened for inclusion. Randomized controlled trials on pancreatic stent for preventing post-endoscopic restrograde cholangiopancreatography pancreatitis (PEP) were identified.The systematic review was conducted using methods recommended by the Cochrane Collaboration. Results Six trials involving 468 high-risk patients for post-ERCP pancreatitis were included. The incidence of post-ERCP pancreatitis was significantly reduced by pancreatic duct stenting (Peto RR 0.31, 95% CI 0.19 to 0.52; P＜0.000 01; NNT=6). The incidence of severe PEP was also significantly lower in pancreatic duct stenting group compared with the control group (Peto OR 0.13, 95% CI 0.04 to 0.47; P=0.002; NNT=24). The results were consistent with the sensitivity-analysis when abstracts were excluded. Conclusion Pancreatic duct stenting appears to be an effective method to prevent PEP. Due to the limitation of the included trials and their methodology, the results should be considered with caution. High quality and large-scale trials are required.