Alonso-Coello Pablo, Mills Ed, Heels-Ansdell Diane, López-Yarto Maite, Zhou Qi, Johanson John F, Guyatt Gordon
Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain.
Am J Gastroenterol. 2006 Jan;101(1):181-8. doi: 10.1111/j.1572-0241.2005.00359.x.
To evaluate the impact of laxatives on a wide range of symptoms in patients with symptomatic hemorrhoids.
We searched using the following sources: MEDLINE, EMBASE, CINAHL and CENTRAL, BIOSIS, AMED, Papers First and Proceedings; study authors, industry, and experts in the field. We included all published and unpublished parallel group randomized controlled trials comparing any type of laxative to placebo or no therapy in patients with symptomatic hemorrhoids. Two reviewers independently screened studies for inclusion, retrieved all potentially relevant studies, and extracted data on study population, intervention, prespecified outcomes, and methodology.
Seven trials randomized 378 patients to fiber or a nonfiber control. Studies were of moderate quality for most outcomes. Meta-analyses using random effects models suggested that fiber has an apparent beneficial effect. The risk of not improving/persisting symptoms decreased by 47% in the fiber group (RR = 0.53, 95% CI 0.38-0.73) and the risk of bleeding by 50% (RR = 0.50, 95% CI 0.28-0.89). Studies with multiple follow-ups, usually at 6 wk and at 3 months, showed consistent results over time. Results are also compatible with large treatment effects in prolapse, pain, and itching, but even in the pooled analyses confidence intervals were wide and compatible with no effect (RR = 0.79, 95% CI 0.37-1.67; RR = 0.33, 95% CI 0.07-1.65; and RR = 0.71, 95% CI 0.24-2.10, respectively). One study suggested a decrease in recurrence. Results showed a nonsignificant trend toward increases in mild adverse events in the fiber group (RR = 6.0, 95% CI 0.57-64.8).
Trials of fiber show a consistent beneficial effect for symptoms and bleeding in the treatment of symptomatic hemorrhoids.
评估泻药对有症状的痔疮患者多种症状的影响。
我们通过以下来源进行检索：医学期刊数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）和考克兰系统评价数据库（CENTRAL）、生物学文摘数据库（BIOSIS）、联合和补充医学数据库（AMED）、论文优先数据库和会议录数据库；研究作者、行业及该领域专家。我们纳入了所有已发表和未发表的平行组随机对照试验，这些试验比较了任何类型的泻药与安慰剂或无治疗措施对有症状的痔疮患者的效果。两名评价者独立筛选纳入研究，检索所有潜在相关研究，并提取有关研究人群、干预措施、预先设定的结局和方法的数据。
七项试验将378例患者随机分为纤维组或非纤维对照组。大多数结局的研究质量中等。采用随机效应模型的荟萃分析表明，纤维有明显的有益作用。纤维组症状未改善/持续存在的风险降低了47%（相对危险度RR = 0.53，95%可信区间CI 0.38 - 0.73），出血风险降低了50%（RR = 0.50，95% CI 0.28 - 0.89）。多次随访（通常在6周和3个月时）的研究随着时间推移显示出一致的结果。结果也与脱垂、疼痛和瘙痒方面的大治疗效果相符，但即使在汇总分析中，可信区间也很宽，与无效果相符（RR分别为0.79，95% CI 0.37 - 1.67；RR = 0.33，95% CI 0.07 - 1.65；RR = 0.71，95% CI 0.24 - 2.10）。一项研究提示复发率降低。结果显示纤维组轻度不良事件增加的趋势无统计学意义（RR = 6.0，95% CI 0.57 - 64.8）。
纤维治疗有症状痔疮的试验显示对症状和出血有一致的有益作用。
