The American journal of gastroenterology
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Am. J. Gastroenterol. · Jul 2009
Review Meta AnalysisEfficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis.
Irritable bowel syndrome (IBS) is a chronic functional disorder. 5-Hydroxytryptamine (5-HT) is a key modulator of gastrointestinal sensorimotor function. Many patients have IBS that can be difficult to treat, which has led to the development of newer agents, such as 5-HT(3) antagonists and 5-HT(4) agonists. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the efficacy of all available 5-HT agents in IBS. ⋯ Alosetron, cilansetron, and tegaserod are all effective in the treatment of IBS. Serious adverse events were rare in the eligible RCTs included in this systematic review.
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Am. J. Gastroenterol. · Jun 2009
Review Meta AnalysisMeta-analysis of randomized clinical trials comparing open and laparoscopic anti-reflux surgery.
The aim of this study was to conduct a meta-analysis of randomized evidence to determine the relative merits of laparoscopic anti-reflux surgery (LARS) and open anti-reflux surgery (OARS) for proven gastro-esophageal reflux disease (GERD). ⋯ On the basis of this meta-analysis, the authors conclude that LARS is an effective and safe alternative to OARS for the treatment of proven GERD. LARS enables a faster convalescence and return to productive activity, with a reduced risk of complications and a similar treatment outcome, than an open approach. However, there is a significantly higher rate of re-operation (79%) in the LARS group.
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Am. J. Gastroenterol. · Apr 2009
Review Meta AnalysisOral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis.
Spontaneous bacterial peritonitis (SBP) is a serious complication of advanced liver disease resulting in high mortality rates. Although studies that assessed the use of oral antibiotics in advanced liver disease demonstrated a clear benefit in reducing the risk of recurrent peritonitis, it is unclear whether mortality rates are similarly affected by this practice. The goal of this study was to determine whether oral antibiotic therapy provides a survival benefit for patients with advanced cirrhosis and ascites. Through subgroup analysis, we also evaluated the effect of prophylactic oral antibiotic therapy on the prevention of SBP and the incidence of all infections (including SBP) when compared with non-treated or placebo controls. ⋯ Antibiotic prophylaxis improved short-term survival in treated patients when compared with untreated control groups and reduced the overall risk of infections, including SBP, during follow-up. In summary, antibiotic prophylaxis should be considered for high-risk cirrhotic patients with ascites.
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Am. J. Gastroenterol. · Feb 2009
Review Meta Analysis Comparative StudyRadiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials.
Radiofrequency thermal ablation (RF) and percutaneous ethanol injection (PEI) have been employed in the treatment of small hepatocellular carcinoma (HCC) as curative treatments. The aim of the study was to review the available evidence comparing RF to PEI for small HCC. ⋯ RF ablation is superior to PEI in the treatment of small HCC with respect to overall survival, 1, 2, and 3 years survival rates, 1, 2, and 3 cancer-free survival rates, and tumor response. RF shows a significantly smaller risk of local recurrence.
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Am. J. Gastroenterol. · Feb 2009
Review Meta AnalysisHelicobacter pylori infection and Barrett's esophagus: a systematic review and meta-analysis.
The majority of distal esophageal adenocarcinomas are believed to arise in patients with Barrett's esophagus (BE). Helicobacter pylori (H. pylori) infection plays an etiological role in gastric carcinogenesis, but any possible role in BE is uncertain. We aimed to explore the possible relationship between H. pylori infection and BE by meta-analysis. ⋯ H. pylori infection and BE are inversely related when compared with endoscopically normal controls but not blood donor controls. Limited evidence suggests that there is no clear association between H. pylori infection and BE. To determine more accurately the effect size of H. pylori infection in BE, high quality prospective case-control studies with age-matched, endoscopically normal healthy controls are needed.