Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis
Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis
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DOI：
10.1136/gut.2008.163162
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发表时间：
2009-03-01
期刊：
影响因子：
24.5
通讯作者：
Moayyedi, P.
中科院分区：
文献类型：
--
作者：
Ford, A. C.;Talley, N. J.;Moayyedi, P.
目的：肠易激综合征（IBS）是一种慢性功能性胃肠道疾病。抗抑郁药和心理疗法治疗的证据是相互矛盾的。设计：随机对照试验（RCT）的系统回顾和荟萃分析。检索MEDLINE、EMBASE和科克伦对照试验注册库（截至2008年5月）。设置：基于初级、二级和三级护理的RCT。患者：患有IBS的成人。干预措施：抗抑郁药与安慰剂，心理治疗与对照治疗或“常规治疗”。主要结果测量：合并二分症状数据，以获得治疗后仍有症状的相对风险（RR）和95%置信区间（CI）。需要治疗的数量（NNT）从风险差的倒数计算。结果：检索策略确定了571引文。32项随机对照试验符合入选条件：19项比较心理治疗与对照治疗或“常规治疗”，12项比较抗抑郁药与安慰剂，1项比较心理治疗和抗抑郁药与安慰剂。抗抑郁药试验的研究质量总体良好，但心理治疗试验的研究质量较差。与安慰剂相比，抗抑郁药治疗IBS症状持续存在的RR为0.66（95%CI，0.57至0.78），三环类抗抑郁药和选择性5-羟色胺再摄取抑制剂的治疗效果相似。心理治疗后症状持续存在的RR为0.67（95%CI为0.57 ~ 0.79）。两种干预措施的NNT均为4。结论：抗抑郁药治疗IBS有效。IBS常规使用心理疗法的高质量证据较少，但现有数据表明这些疗法可能具有相当的疗效。
Objective: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting.Design: Systematic review and meta-analysis of randomised controlled trials (RCTs). MEDLINE, EMBASE and the Cochrane Controlled Trials Register were searched (up to May 2008).Setting: RCTs based in primary, secondary and tertiary care.Patients: Adults with IBS.Interventions: Antidepressants versus placebo, and psychological therapies versus control therapy or "usual management''.Main outcome measures: Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference.Results: The search strategy identified 571 citations. Thirty-two RCTs were eligible for inclusion: 19 compared psychological therapies with control therapy or "usual management'', 12 compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Study quality was generally good for antidepressant but poor for psychological therapy trials. The RR of IBS symptoms persisting with antidepressants versus placebo was 0.66 (95% CI, 0.57 to 0.78), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms persisting with psychological therapies was 0.67 (95% CI, 0.57 to 0.79). The NNT was 4 for both interventions.Conclusions: Antidepressants are effective in the treatment of IBS. There is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.