Alimentary pharmacology & therapeutics
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Aliment. Pharmacol. Ther. · Jul 2020
Meta AnalysisSystematic review with meta-analysis: efficacy and safety of treatments for opioid-induced constipation.
When opioid-induced constipation is treated with centrally acting opioid antagonists, there may be opioid withdrawal or aggravation of pain due to inhibition of μ-opioid analgesia. This led to the development of peripherally acting μ-opioid receptor antagonists (PAMORAs). ⋯ Therapeutic response in opioid-induced constipation is best achieved with the PAMORAs, methylnaltrexone, naloxegol and naldemidine, which are associated with low risk of serious adverse events.
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Aliment. Pharmacol. Ther. · Jun 2020
Meta AnalysisSystematic review with meta-analysis: the efficacy of tranexamic acid in upper gastrointestinal bleeding.
Upper gastrointestinal bleeding is a common medical emergency associated with substantial mortality. Tranexamic acid may be effective for reducing mortality in upper gastrointestinal bleeding. ⋯ Moderate-quality evidence shows that tranexamic acid is superior to placebo for the reduction in mortality in patients with upper gastrointestinal bleeding. While our findings lend further support to the use of tranexamic acid for treating patients with upper gastrointestinal bleeding, additional higher-quality trials are needed.
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Aliment. Pharmacol. Ther. · Apr 2020
Meta AnalysisSystematic review with meta-analysis: Saccharomyces boulardii for treating acute gastroenteritis in children-a 2020 update.
There is still controversy with regard to the efficacy of individual probiotic strains for the management of acute gastroenteritis. ⋯ In children with acute gastroenteritis, low- to very low-quality evidence suggests that S boulardii confers a benefit for several diarrhoeal outcomes.
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Aliment. Pharmacol. Ther. · Jun 2019
Meta AnalysisSystematic review with meta-analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children - a 2019 update.
Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children. ⋯ Despite a recent large RCT demonstrating no effect of L rhamnosus GG, current evidence shows that, overall, L rhamnosus GG reduced both the duration of diarrhoea (with a higher impact in European countries) and hospitalisation in inpatients. These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials.
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Aliment. Pharmacol. Ther. · Aug 2018
Meta AnalysisSystematic review and network meta-analysis: first- and second-line biologic therapies for moderate-severe Crohn's disease.
There are limited data to inform positioning of agents for treating moderate-severe Crohn's disease (CD). ⋯ Indirect comparisons suggest that infliximab or adalimumab may be preferred first-line agents, and ustekinumab a preferred second-line agent, for induction of remission in patients with moderate-severe CD. Head-to-head trials are warranted.