Efficacy of antidepressants in irritable bowel syndrome: an updated systematic review and meta-analysis controlling for depression
Notice bibliographique
Résumé
Introduction Antidepressants may be effective for the treatment of irritable bowel syndrome, but some experts are sceptical, and effect of co-existent depression has not been controlled for in previous meta-analyses. We updated a previous systematic review to estimate their efficacy in the treatment of IBS and examine this issue. Methods MEDLINE, EMBASE and the Cochrane Controlled Trials Register were searched (up to November 2010) to identify randomised controlled trials (RCTs) comparing antidepressants with placebo in adult IBS patients. Subjects were required to be followed up for at least 1 week, and studies had to report either a global assessment of IBS symptom cure or improvement, or abdominal pain cure or improvement, after completion of therapy. Data were extracted as intention-to-treat analyses with drop-outs assumed to be treatment failures, and pooled using a random effects model. Effect of antidepressants compared to placebo was reported as the relative risk (RR) of remaining symptomatic, with a 95% CI. Trials that screened for and excluded depressed individuals were pooled separately in a subgroup analysis. Results 16 RCTs were eligible for inclusion, including 1022 patients, 554 of whom received antidepressants and 468 placebo. Nine RCTs used tricyclic antidepressants (TCAs), six RCTs selective serotonin reuptake inhibitors (SSRIs), and one RCT both. There were 242 (43.7%) patients assigned to antidepressant therapy with persistent or unimproved IBS symptoms following therapy, compared to 314 (64.9%) allocated to placebo (RR of IBS symptoms persisting = 0.67; 95% CI 0.56 to 0.78). When the 10 RCTs of TCAs were pooled, 166 (43.9%) of 378 had persistent symptoms, compared to 189 (62.2%) of 304 receiving placebo (RR = 0.70; 95% CI 0.60 to 0.83). In the five RCTs of SSRIs 76 (43.2%) of 176 patients allocated to SSRIs had persistent symptoms, compared to 125 (69.4%) of 180 placebo patients (RR = 0.63; 95% CI 0.44 to 0.91). When only the four RCTs that screened for and excluded depressed individuals were included in the analysis RR of symptoms persisting was 0.73 (95% CI 0.47 to 1.15), compared with a RR of 0.65 (95% CI 0.55 to 0.78) in the other 12 trials. However, this difference was not statistically significant (Cochrane Q = 0.64). Conclusion Evidence continues to accumulate for the efficacy of antidepressants in the treatment of IBS. However, part of their beneficial effect may stem from the treatment of co-existent depression. More RCTs examining their efficacy in non-depressed IBS patients are required to clarify this issue.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».