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The Cochrane Database of Systematic... Apr 2018Postoperative ileus is a major complication for persons undergoing abdominal surgery. Daikenchuto, a Japanese traditional medicine (Kampo), is a drug that may reduce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative ileus is a major complication for persons undergoing abdominal surgery. Daikenchuto, a Japanese traditional medicine (Kampo), is a drug that may reduce postoperative ileus.
OBJECTIVES
To assess the efficacy and safety of Daikenchuto for reducing prolonged postoperative ileus in persons undergoing elective abdominal surgery.
SEARCH METHODS
We searched the following databases on 3 July 2017: CENTRAL, MEDLINE, Embase, ICHUSHI, WHO (World Health Organization) International Clinical Trials Registry Platform (ICTRP), EU Crinical Trials registry (EU-CTR), UMIN Clinical Trials Registry (UMIN-CTR), ClinicalTrials.gov, The Japan Society for Oriental Medicine (JSOM), American Society of Clinical Oncology (ASCO), Society of American Gastrointestinal and Endscopic Surgeons (SAGES). We set no limitations on language or date of publication.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing Daikenchuto with any control condition in adults, 18 years of age or older, undergoing elective abdominal surgery.
DATA COLLECTION AND ANALYSIS
We applied standard methodological procedures expected by Cochrane. Two review authors independently reviewed the articles identified by literature searches, extracted data, and assessed risk of bias of the included studies using the Cochrane software Review Manager 5.
MAIN RESULTS
We included seven RCTs with a total of 1202 participants. Overall, we judged the risk of bias as low in four studies and high in three studies. We are uncertain whether Daikenchuto reduced time to first flatus (mean difference (MD) -11.32 hours, 95% confidence interval (CI) -17.45 to -5.19; two RCTs, 83 participants; very low-quality evidence), or time to first bowel movement (MD -9.44 hours, 95% CI -22.22 to 3.35; four RCTs, 500 participants; very low-quality evidence) following surgery. There was little or no difference in time to resumption of regular solid food following surgery (MD 3.64 hours, 95% CI -24.45 to 31.74; two RCTs, 258 participants; low-quality evidence). There were no adverse events in either arm of the five RCTs that reported on drug-related adverse events (risk difference (RD) 0.00, 95% CI -0.02 to 0.02, 568 participants, low-quality evidence). We are uncertain of the effect of Daikenchuto on patient satisfaction (MD 0.09, 95% CI -0.19 to 0.37; one RCT, 81 participants; very low-quality of evidence). There was little or no difference in the incidence of any re-interventions for postoperative ileus before leaving hospital (risk ratio (RR) 0.99, 95% CI 0.06 to 15.62; one RCT, 207 participants; moderate-quality evidence), or length of hospital stay (MD -0.49 days, 95% CI -1.21 to 0.22; three RCTs, 292 participants; low-quality evidence).
AUTHORS' CONCLUSIONS
Evidence from current literature was unclear whether Daikenchuto reduced postoperative ileus in patients undergoing elective abdominal surgery, due to the small number of participants in the meta-analyses. Very low-quality evidence means we are uncertain whether Daikenchuto improved postoperative flatus or bowel movement. Further well-designed and adequately powered studies are needed to assess the efficacy of Daikenchuto.
Topics: Abdomen; Defecation; Elective Surgical Procedures; Flatulence; Humans; Ileus; Panax; Patient Satisfaction; Plant Extracts; Postoperative Complications; Randomized Controlled Trials as Topic; Time Factors; Zanthoxylum; Zingiberaceae
PubMed: 29619778
DOI: 10.1002/14651858.CD012271.pub2 -
TheScientificWorldJournal 2022Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intestinal helminth infections are still public health problems in tropical and subtropical countries including Ethiopia. This review and meta-analysis aimed to produce the pooled prevalence and associated risk factors of human intestinal helminth parasitic infections (HIHPIs) in Ethiopia.
METHODS
Articles written in English were searched from online databases. Sixty-seven studies were included. Meta-analysis was computed using STATA version 14.
RESULT
The pooled prevalence of HIHPIs was (33.35%, 95% CI: 28.85%, 37.86%). (10.84%, 95% CI: 9.34, 12.34), hookworm spp. (8.89%, 95% CI: 7.75, 10.04), (4.22%, 95% CI: 3.64, 4.81), (2.51%, 95% CI: 2.17, 2.86), (2.29%, 95% CI: 1.96, 2.63), species (1.01%, 95% CI: 0.80, 1.22), (1.17%, 95% CI: 0.92, 1.41), and (0.71%, 95% CI: 0.52, 0.90) were recorded. Handwashing before food (OR: 5.22,95% CI: 3.49, 6.94), handwashing after toilet (OR: 3.03, 95%; CI: 1.01, 5.05), age (OR: 1.66, 95% CL. 1.09, 2.23), open defecation (OR: 2.42, 95% CI: 1.60, 3.24), eating raw and unwashed vegetables/fruits (OR: 1.98, 95%; CI: 1.30, 2.66), maternal education (OR: 1.81, 95% CI: 0.91, 2.72), family income (OR: 2.00, 95% CI: 0.87, 3.31), source of drinking water (OR: 3.12, 95% CI: 1.96, 4.27), swimming/contact with river water (OR: 1.90, 95% CI: 1.11, 2.69), barefoot (OR: 3.28, 95% CI: 1.67, 4.88), playing with soil (OR: 2.64, 95% CI: 1.40, 3.88), and family size (OR: 3.75, 95% CI: 2.03, 5.46) were factors associated with HIHPIs in Ethiopia. High heterogeneity of the prevalence of HIHPIs was observed among the studies within and among regions (I > 99.6% and ≤ 0.001).
CONCLUSION
HIHPIs in Ethiopia were significantly high. Therefore, special attention should be given by all stakeholders to minimize HIHPIs in Ethiopia.
Topics: Animals; Cross-Sectional Studies; Ethiopia; Helminthiasis; Helminths; Humans; Intestinal Diseases, Parasitic; Prevalence; Risk Factors
PubMed: 36093316
DOI: 10.1155/2022/3905963 -
Frontiers in Oncology 2021Given the expanding clinical applications of laparoscopic surgery and neoadjuvant chemotherapy in advanced gastric cancer treatment, there is an emerging need to...
BACKGROUND
Given the expanding clinical applications of laparoscopic surgery and neoadjuvant chemotherapy in advanced gastric cancer treatment, there is an emerging need to summarize the few evidences that evaluated the safety and efficacy of laparoscopic versus open gastrectomy in patients with advanced gastric cancer (AGC) following neoadjuvant chemotherapy (NAC).
METHODS
From January 1 to 2, 2021, we searched Ovid Embase, PubMed, Cochrane central register Trials (Ovid), and web of science to find relevant studies published in English, and two authors independently performed literature screening, quality assessment of the included studies, data extraction, and data analysis. This study was registered with PROSPERO (CRD42021228845).
RESULTS
The initial search retrieved 1567 articles, and 6 studies were finally included in the meta-analysis review, which comprised 2 randomized control trials and 4 observational studies involving 288 laparoscopic gastrectomy (LG) and 416 open gastrectomy (OG) AGC patients treated with NAC. For intraoperative conditions, R0 resection rate, blood transfusion, intraoperative blood loss, number of lymph nodes dissected, proximal margin, and distal margin were comparable between LG group and open OG group. For postoperative short-term clinical outcomes, LG has significantly less postoperative complications (OR = 0.65, 95%CI: 0.42-1.00, p = 0.05) and shorter postoperative time to first aerofluxus (WMD = -0.57d, 95%CI: -0.89-0.25, p = 0.0004) than OG, and anastomotic leakage, pulmonary infection, pleural effusion, surgical site infection, thrombosis, intestinal obstruction, peritoneal effusion or abscess formation, postoperative time to first defecation, postoperative time to first liquid diet, and postoperative length of stay were comparable between the two groups. For postoperative survival outcomes, there were no significant differences in disease-free survival (DFS) and overall survival (OS) between the two groups.
CONCLUSION
The available evidences indicated that LG is an effective and feasible technology for the treatment of AGC patients treated with NAC, and LG patients have much less postoperative complications and faster bowel function recovery than OG patients.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO database (identifier, CRD42021228845).
PubMed: 34422658
DOI: 10.3389/fonc.2021.704244 -
BMC Pregnancy and Childbirth Apr 2017Gum chewing has been reported to enhance the intestinal function recovery after caesarean section, current perspectives and practice guidelines vary widely on the use of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gum chewing has been reported to enhance the intestinal function recovery after caesarean section, current perspectives and practice guidelines vary widely on the use of gum chewing, more studies on the role of gum chewing after caesarean section are needed.
METHODS
We performed a comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy of gum chewing after caesarean section. Studies were identified by searching EMBASE et al database (until June 30, 2016). Summary odd ratios or weighted mean differences with 95% confidence intervals were calculated for each outcome with fixed- or random-effects model.
RESULTS
Ten RCTs with a total of 1659 women were included in our meta-analysis. Gum chewing provided significant benefits in reducing the time to first passage of flatus, first defecation, first bowel sound, first bowel movement and the length of hospital stay, but not in the time to first feeling of hunger.
CONCLUSIONS
Gun chewing hastens the intestinal function recovery after caesarean section and offers a safe and inexpensive option. High-quality and larger-scale RCTs are still warranted to clarify the role of gum chewing in intestinal function recovery after caesarean section.
Topics: Cesarean Section; Chewing Gum; Female; Gastrointestinal Motility; Humans; Ileus; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Recovery of Function
PubMed: 28415967
DOI: 10.1186/s12884-017-1286-8 -
BMJ Open Jan 2024This study aimed to pool the efficacy in bowel movement and explore the change of gut microbiota on adult functional constipated patients after probiotics-containing... (Meta-Analysis)
Meta-Analysis
Efficacy in bowel movement and change of gut microbiota on adult functional constipation patients treated with probiotics-containing products: a systematic review and meta-analysis.
OBJECTIVES
This study aimed to pool the efficacy in bowel movement and explore the change of gut microbiota on adult functional constipated patients after probiotics-containing products treatment.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Cochrane Library for published studies and ClinicalTrials.gov for 'grey' researches were independently investigated for randomised controlled trials up to November 2022.
ELIGIBILITY CRITERIA, DATA EXTRACTION AND SYNTHESIS
The intervention was probiotics-containing product, either probiotics or synbiotics, while the control was placebo. The risk of bias was conducted. The efficacy in bowel movement was indicated by stool frequency, stool consistency and Patient Assessment of Constipation Symptom (PAC-SYM), while the change of gut microbiota was reviewed through α diversity, β diversity, change/difference in relative abundance and so on. The subgroup analysis, sensitivity analysis and random-effect meta-regression were conducted to explore the heterogeneity. The Grading of Recommendations Assessment Development and Evaluation was conducted to grade the quality of evidence.
RESULTS
17 studies, comprising 1256 participants, were included with perfect agreements between two researchers (kappa statistic=0.797). Compared with placebo, probiotics-containing products significantly increased the stool frequency (weighted mean difference, WMD 0.93, 95% CI 0.47 to 1.40, p=0.000, I=84.5%, 'low'), improved the stool consistency (WMD 0.38, 95% CI 0.05 to 0.70, p=0.023, I²=81.6%, 'very low') and reduced the PAC-SYM (WMD -0.28, 95% CI: -0.45 to -0.11, p=0.001, I²=55.7%, 'very low'). In subgroup analysis, synbiotics was superior to probiotics to increase stool frequency. Probiotics-containing products might not affect α or β diversity, but would increase the relative abundance of specific strain.
CONCLUSIONS
Probiotics-containing products, significantly increased stool frequency, improved stool consistency, and alleviated functional constipation symptoms. They increased the relative abundance of specific strain. More high-quality head-to-head randomised controlled trials are needed.
Topics: Adult; Humans; Constipation; Defecation; Gastrointestinal Microbiome; Probiotics; Synbiotics
PubMed: 38238054
DOI: 10.1136/bmjopen-2023-074557 -
Safety and efficacy of laxatives after major abdominal surgery: systematic review and meta-analysis.BJS Open Aug 2020Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recovery of gastrointestinal function is often delayed after major abdominal surgery, leading to postoperative ileus (POI). Enhanced recovery protocols recommend laxatives to reduce the duration of POI, but evidence is unclear. This systematic review aimed to assess the safety and efficacy of laxative use after major abdominal surgery.
METHODS
Ovid MEDLINE, Embase, Cochrane Library and PubMed databases were searched from inception to May 2019 to identify eligible RCTs focused on elective open or minimally invasive major abdominal surgery. The primary outcome was time taken to passage of stool. Secondary outcomes were time taken to tolerance of diet, time taken to flatus, length of hospital stay, postoperative complications and readmission to hospital.
RESULTS
Five RCTs with a total of 416 patients were included. Laxatives reduced the time to passage of stool (mean difference (MD) -0·83 (95 per cent c.i. -1·39 to -0·26) days; P = 0·004), but there was significant heterogeneity between studies for this outcome measure. There was no difference in time to passage of flatus (MD -0·17 (-0·59 to 0·25) days; P = 0·432), time to tolerance of diet (MD -0·01 (-0·12 to 0·10) days; P = 0·865) or length of hospital stay (MD 0·01(-1·36 to 1·38) days; P = 0·992). There were insufficient data available on postoperative complications for meta-analysis.
CONCLUSION
Routine postoperative laxative use after major abdominal surgery may result in earlier passage of stool but does not influence other postoperative recovery parameters. Better data are required for postoperative complications and validated outcome measures.
Topics: Abdomen; Data Management; Defecation; Elective Surgical Procedures; Humans; Ileus; Laxatives; Postoperative Complications; Randomized Controlled Trials as Topic; Time Factors
PubMed: 32459069
DOI: 10.1002/bjs5.50301 -
BMC Gastroenterology Oct 2015Trans-anal irrigation (TAI) is used widely to treat bowel dysfunction, although evidence for its use in adult chronic functional constipation remains unclear. Long-term... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Trans-anal irrigation (TAI) is used widely to treat bowel dysfunction, although evidence for its use in adult chronic functional constipation remains unclear. Long-term outcome data are lacking, and the effectiveness of therapy in this patient group is not definitively known.
METHODS
Evidence for effectiveness and safety was reviewed and the quality of studies was assessed. Primary research articles of patients with chronic functional constipation, treated with TAI as outpatients and published in English in indexed journals were eligible. Searching included major bibliographical databases and search terms: bowel dysfunction, defecation, constipation and irrigation. Fixed- and random-effect meta-analyses were performed.
RESULTS
Seven eligible uncontrolled studies, including 254 patients, of retrospective or prospective design were identified. The definition of treatment response varied and was investigator-determined. The fixed-effect pooled response rate (the proportion of patients with a positive outcome based on investigator-reported response for each study) was 50.4 % (95 % CI: 44.3-56.5 %) but featured substantial heterogeneity (I(2) = 67.1 %). A random-effects estimate was similar: 50.9 % (95 % CI: 39.4-62.3 %). Adverse events were inconsistently reported but were commonplace and minor.
CONCLUSIONS
The reported success rate of irrigation for functional constipation is about 50 %, comparable to or better than the response seen in trials of pharmacological therapies. TAI is a safe treatment benefitting some patients with functional constipation, which is a chronic refractory condition. However findings for TAI vary, possibly due to varying methodology and context. Well-designed prospective trials are required to improve the current weak evidence base.
Topics: Adult; Anal Canal; Chronic Disease; Constipation; Female; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Therapeutic Irrigation; Treatment Outcome
PubMed: 26474758
DOI: 10.1186/s12876-015-0354-7 -
Medicine Feb 2020The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis. (Comparative Study)
Comparative Study
INTRODUCTION
The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis.
METHODS AND ANALYSIS
We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals.
ETHICS AND DISSEMINATION
The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences.
PROSPERO REGISTRATION NUMBER
CRD42019147503.
Topics: Abdominal Pain; Acupuncture Therapy; China; Defecation; Humans; Length of Stay; Meta-Analysis as Topic; Pancreatitis; Randomized Controlled Trials as Topic; Severity of Illness Index; Visual Analog Scale
PubMed: 32080079
DOI: 10.1097/MD.0000000000019044 -
Evidence-based Complementary and... 2021Evidence for the efficacy and safety of electroacupuncture (EA) on gastrointestinal function recovery after gynecological surgery is unclear. (Review)
Review
BACKGROUND
Evidence for the efficacy and safety of electroacupuncture (EA) on gastrointestinal function recovery after gynecological surgery is unclear.
OBJECTIVE
This meta-analysis aimed to evaluate the effects of EA on recovery of postoperative gastrointestinal function for patients receiving gynecological surgery. Data sources: PubMed, Cochrane Central Register of Controlled Trials (CINAHL), Embase, China National Knowledge Infrastructure (CNKI), Weipu (CQVIP), and Wanfang databases were systematically searched from the inception dates to May 30, 2020, for relevant randomized controlled trials (RCTs). Study selection: RCTs that evaluated EA for postoperative gastrointestinal function directly related to gynecological surgery in adults aged 18 years or over. Data extraction and synthesis: paired reviewer independently extracted the data and assessed study quality. Standardized mean differences (SMD) were calculated as the effect measure from a random effects model. Main outcomes and measures: time to first flatus (TFF), time to bowel sounds recovery (TBS), and time to first defecation (TFD) were recorded as primary outcomes; postoperative nausea and vomiting (PONV), motilin (MTL), gastrin (GAS), pH value of gastric mucosa (pHi), gastric mucosal partial pressure of carbon dioxide (PgCO2), vasoactive intestinal peptide (VIP), and adverse event were reported as secondary outcomes.
RESULTS
We included eighteen RCTs (1117 participants). Our findings suggested that compared to the control group (CG), electroacupuncture group (EG) showed significant effects on TFF (SMD = -0.98, 95% CI: [-1.28, -0.68], < 0.00001, = 69%), TBS (SMD = -0.98, 95% CI: [-1.84, -0.12], =0.03, = 92%), and TFD (SMD = -1.23, 95% CI: [-1.59, -0.88], < 0.0001, = 0%). Moreover, the incidence of PONV at postoperative 6 h (OR = 0.42, 95% CI: [0.27, 0.64], < 0.0001, = 0%) and 24 h (OR = 0.46, 95% CI: [0.32, 0.68], < 0.0001, = 0%) was lower in the EG than that in the CG, whereas no significant difference in ratio of PONV at postoperative 48 h (OR = 0.55, 95% CI: [0.20, 1.51], =0.25, = 0%) was detected between the two groups. Meanwhile, there was a significant effect in favor of EA on the level of MTL at postoperative 6 h (SMD = -0.93, 95% CI: [-1.36, -0.61], < 0.0001, = 21%), while no significant effect was observed at postoperative 24 h (SMD = -0.43, 95% CI: [-0.89, 0.02], =0.06, = 69%) in the EG when compared to the CG. Additionally, a large significant effect on decreasing PgCO was found in the EG in comparison to the CG, but no significant effect in favor of EA on GAS, VIP, or pHi was observed. It was reported that there was one participant with pain at the needling sites and bruising, and three participants withdrew because they were not intolerant to EA.
CONCLUSIONS
EA could be a promising strategy for the prevention and treatment of gastrointestinal dysfunction after gynecological surgery, including shortening TFF and TFD, TBS, regulating MTL, and decreasing the ratio of PONV within postoperative 24h. The effects on MTL and PONV varied with different intervention points, and EA used at 30 min prior to surgery might be recommended. However, the evidence quality ranged from low to very low, and large-scale and high-quality RCTs were warranted.
PubMed: 34970326
DOI: 10.1155/2021/8329366 -
Annals of Palliative Medicine Dec 2021The purpose of this study was to evaluate the clinical effects and safety of neostigmine for the postoperative recovery of gastrointestinal function. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The purpose of this study was to evaluate the clinical effects and safety of neostigmine for the postoperative recovery of gastrointestinal function.
METHODS
We performed a literature search of multiple databases [PubMed, Web of Science, Cochrane Library and China National Knowledge Internet (CNKI)] to retrieve studies comparing the postoperative gastrointestinal function of neostigmine and control groups. Review Manager 5.2 was applied for the analysis of heterogeneity, sensitivity, and bias.
RESULTS
After screening the articles, 17 trials involving 1,589 postoperative patients that met the eligibility criteria were included. The results suggested that neostigmine improved the first passage of flatus [standard mean difference (SMD) =-3.00; 95% confidence interval (CI): (-4.03, -1.97); P<0.001), first defecation [SMD =-3.75; 95% CI: (-5.25, -2.24); P<0.001], time of bowel sound recovery [SMD =-3.42; 95% CI: (-4.49, -2.36), P<0.001], and gastrointestinal function recovery [risk ratio (RR) =1.84; 95% CI: (1.19, 2.86); P=0.007]. Compared to the control group, the neostigmine group had lower rates of abdominal distention [RR =0.39; 95% CI: (0.18, 0.87); P=0.02; I2=76%] and overall adverse events [RR =0.49; 95% CI: (0.29, 0.82); P=0.007]. However, two groups had no difference in postoperative nausea and vomiting (PONV) [RR =0.50; 95% CI: (0.21, 1.23); P=0.13], and respiratory complications [RR =0.96; 95% CI: (0.20, 4.53); P=0.96]. Sensitivity and publication bias analyses showed that these results were robust and exhibited little publication bias.
DISCUSSION
Small doses of neostigmine may promote the recovery of postoperative gastrointestinal function without obvious side effects.
Topics: China; Humans; Neostigmine; Postoperative Nausea and Vomiting
PubMed: 35016456
DOI: 10.21037/apm-21-3291