Efficacy of opioid receptor modulators in patients with irritable bowel syndrome: A systematic review and meta-analysis.
Efficacy of opioid receptor modulators in patients with irritable bowel syndrome: A systematic review and meta-analysis.
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DOI：
10.1097/md.0000000000024361
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发表时间：
2021-01-29
期刊：
影响因子：
1.6
通讯作者：
Wang F
中科院分区：
文献类型：
--
作者：
Li X;Li B;Zhang J;Chen T;Wu H;Shi X;Ma J;Qin J;Tang X;Wang F
肠易激综合征（IBS）是临床上最常见的功能性胃肠道疾病之一，其发病机制多种多样。由于其发病突然，症状迁延不愈，严重影响患者的工作和生活。阿片受体是分布在脑、脊髓、皮肤和胃肠道的G蛋白偶联受体，并且每种亚型具有独特的作用和特异性分布。它们在调节胃肠道中的胃肠运动、分泌和内脏感觉中发挥作用。因此，本荟萃分析旨在评估阿片受体调节剂对改善IBS症状的作用。搜索关键词（肠易激综合征或综合征、肠易激综合征或综合征、肠易激综合征或（阿片受体调节剂OR eluxadoline OR Viberzi OR asimadoline OR loperamide），初步检索PubMed（英文）、EMBASE（英文）、科克伦图书馆（英文），中国知网（CNKI，中文）、万方（中文）、维普引文数据库（中文）和SinoMed（中文）数据库自成立至2019年7月1日共收录中英文论文1023篇。9项研究被纳入最终荟萃分析。由于这是一项系统性综述和荟萃分析，因此不需要伦理批准。基于这9项研究及其4156例患者的随机效应荟萃分析发现，阿片受体调节剂对IBS总体症状（RR = 0.85，95%CI = 0.79-0.92，P <0.01）和排便频率（SMD =-1.26，95%CI =-2.49--0.04，P <0.05）具有统计学显著的有益作用，虽然粪便稠度和生活质量有改善趋势，但这些结果无统计学显著性。 这是第一个检查阿片受体调节剂在IBS中使用的荟萃分析，在现有的试验中报告了很少的不良事件。与对照组相比，eluxadolin在改善IBS总体症状和腹痛方面具有更好的效果，具有统计学意义，并且与其他阿片受体调节剂的已知效果相比，IBS患者便秘发生率较低。然而，目前的研究结果是基于一个相当有限的证据基础上，具有显着的异质性。未来的研究应旨在确定IBS患者的亚群，并需要评估这些治疗的长期安全性。PROSPERO注册号：CRD 42020141597。
While irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal diseases in clinical practice, it has diverse pathogenesis. Because of its sudden and lingering intractable symptoms, it seriously affects patients work and life. Opioid receptors are G protein-coupled receptors distributed across the brain, spinal cord, skin, and gastrointestinal tract, and each of the subtypes has a unique role and specific distribution. They play a role in regulating gastrointestinal motility, secretion, and visceral sensations in the gastrointestinal tract. Therefore, this meta-analysis aims to evaluate the effects of opioid receptor modulators on improving the symptoms of IBS. Searching the key words (Irritable Bowel Syndromes or Syndrome, Irritable Bowel OR Syndromes, Irritable Bowel OR Colon, Irritable OR Irritable Colon OR Colitis, Mucous OR Colitides, Mucous OR Mucous Colitides OR Mucous Colitis) AND (opioid receptor modulators OR eluxadoline OR Viberzi OR asimadoline OR loperamide), a preliminary search on PubMed (English), EMBASE (English), Cochrane Library (English), China National Knowledge Infrastructure Database (CNKI, Chinese), WanFang (Chinese), VIP citation databases (Chinese) and SinoMed (Chinese) databases yielded 1023 papers published in English and Chinese from inception to July 1, 2019. Nine studies were included in the final meta-analysis. Because this is a systematic review and meta-analysis, ethical approval is not necessary. The random-effects meta-analysis based on these 9 studies and their 4156 patients found that opioid receptor modulators have a statistically significant beneficial effect on IBS global symptoms (RR = 0.85, 95%CI = 0.79–0.92, P < .01) and bowel movement frequency (SMD = −1.26, 95%CI = −2.49–−0.04, P < .05), and while there was an improvement trend in stool consistency and quality of life, these findings were not statistically significant. This is the first meta-analysis to examine the use of opioid receptor modulators in IBS, and few adverse events were reported in the available trials. Compared with the control group, eluxadolin has a better effect in improving IBS global symptoms and abdominal pain and has statistical significance and showed a low rate of constipation development in IBS patients in comparison with known effects of other opioid receptor modulators. However, current findings are based on a considerably limited evidence base with marked heterogeneity. Future studies should aim to identify subpopulations of patients with IBS and need to evaluate the long-term safety of these therapies. PROSPERO registration number: CRD42020141597.