Efficacy of gut-brain neuromodulators in irritable bowel syndrome: an updated systematic review and meta-analysis.

We updated a previous systematic reviewand meta-analysisof RCTs examining these questions.

我们更新了之前关于这些问题的RCTs的系统评价和荟萃分析。

Methods

We searched MEDLINE (from Jan 1, 1946, to Jan 1, 2025), Embase and Embase Classic (from Jan 1, 1947, to Jan 1, 2025), and the Cochrane Central Register of Controlled Trials (from database inception to Jan 1, 2025).

我们检索了MEDLINE（从1946年1月1日至2025年1月1日）、Embase和Embase Classic（从1947年1月1日至2025年1月1日）以及Cochrane中央控制试验登记册（从数据库开始至2025年1月1日）。

Trials recruiting adults with IBS and that compared gut-brain neuromodulators versus placebo over at least 4 weeks of treatment were eligible.

符合条件的试验是招募成年肠易激综合症（IBS）患者的，并且比较了至少4周治疗期的肠道-大脑神经调节剂与安慰剂的效果。

Dichotomous symptom data were pooled using a random effects model to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI.

二分法症状数据使用随机效应模型汇总，以获得治疗后仍保持症状的相对风险（RR），并附有95%置信区间。

Results

The search strategy identified 3625 citations. 28 RCTs were eligible containing 2475 patients.

检索策略确定了3625条引文。共有28项随机对照试验（RCTs）符合要求，包含2475名患者。

Ten RCTs were identified since our previous meta-analysis, containing 1348 patients.

自我们上次的荟萃分析以来，识别出10项随机对照试验(RCTs)，包含1348名患者。

The RR of global IBS symptoms not improving with gut-brain neuromodulators versus placebo in 22 RCTs (2222 patients) was 0·77 (95% CI 0·69-0·87).

在22项随机对照试验(RCTs)（共2222名患者）中，使用肠道-脑神经调节剂与安慰剂相比，全球肠易激综合症(IBS)症状未改善的相对风险(RR)为0.77（95%置信区间0.69-0.87）。

The best evidence in terms of persistence of global IBS symptoms was for tricyclic antidepressants (TCAs) in 11 trials (1144 patients; RR 0·70, 0·62-0·80).

在11项试验（1144名患者）中，三环类抗抑郁药（TCAs）对于持续性全球肠易激综合征症状的证据最为充分（相对风险RR 0.70，95%置信区间0.62-0.80）。

The RR of abdominal pain not improving with gut-brain neuromodulators versus placebo in 19 RCTs (1792 patients) was 0·72 (95% CI 0·62-0·83).

在19项随机对照试验（RCTs）（1792名患者）中，与安慰剂相比，肠道-脑神经调节剂未能改善腹痛的相对风险为0.72（95%置信区间0.62-0.83）。

The best evidence was for TCAs in seven trials (708 patients; RR 0·69, 0·54-0·87), but there was also a benefit of selective serotonin reuptake inhibitors in seven RCTs (324 patients; RR 0·74, 0·56-0·99), and serotonin and norepinephrine reuptake inhibitors in two trials (94 patients; RR 0·22, 0·08-0·59).

在七项试验中，三环类抗抑郁药（TCAs）的证据最为充分（708名患者；相对风险0.69，95%置信区间0.54-0.87），选择性5-羟色胺再摄取抑制剂（SSRIs）在七项随机对照试验中也显示出益处（324名患者；相对风险0.74，95%置信区间0.56-0.99），以及在两项试验中，5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）也显示出益处（94名患者；相对风险0.22，95%置信区间0.08-0.59）。

Adverse events were not significantly more common with gut-brain neuromodulators, although rates of withdrawal due to adverse events were significantly higher.

尽管胃肠道脑神经调节剂的不良事件并不显著更常见，但因不良事件导致的撤药率显著更高。

The certainty in the evidence for tricyclic antidepressants for global IBS symptoms was moderate, but it was low to very low for all other endpoints and drug classes studied.

三环类抗抑郁药治疗全球性肠易激综合症状的证据确定性为中等，但对于研究的所有其他终点和药物类别，其确定性为低至非常低。

interpretation

Some gut-brain neuromodulators are efficacious in reducing global symptoms and abdominal pain in IBS.

一些肠道-大脑神经调节剂在减少肠易激综合症的全身症状和腹痛方面是有效的。

The findings support guidelines that recommend use of tricyclic antidepressants for ongoing global symptoms or abdominal pain but also highlight a potential for SSRIs to be modestly effective for abdominal pain.

研究结果支持推荐使用三环类抗抑郁药治疗持续的全身症状或腹痛的指南，但也突显了选择性5-羟色胺再摄取抑制剂（SSRIs）对腹痛可能有适度的疗效。

More data for SNRIs, azapirones, and tetracyclic antidepressants in IBS are required.

需要更多关于SNRIs、阿扎匹隆类药物和四环类抗抑郁药在肠易激综合症（IBS）中的数据。

funding

None.

无。