Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, Minnesota.
Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 2019 May;156(6):1650-1660. doi: 10.1053/j.gastro.2019.01.249. Epub 2019 Jan 31.
BACKGROUND & AIMS: Studies have reported a lack of association between improvements in gastric emptying (GE) and upper gastrointestinal (UGI) symptoms with promotility drugs. However, GE test methods were suboptimal in some studies. We assessed improvements in GE and UGI symptoms in patients given promotility agents in studies with optimal or moderate test methods (scintigraphy or breath test, solid meal, >2 hours duration) compared to studies with suboptimal GE test methods.
With an expert librarian, we completed an extensive search of publications in the Ovid MEDLINE (1946 to present), EMBASE (1988 to January 2018), and EBM Reviews Cochrane Central Register of Controlled Trials, without restrictions on language or year. Two independent reviewers evaluated the following inclusion criteria: randomized, blinded, parallel, or crossover trials of 5HT agonists, D receptor antagonist, or ghrelin agonists; trials that measured change in GE (T) or composite UGI symptoms; trials of patients with functional dyspepsia and gastroparesis; and trials of GE test methods. Standardized mean differences (units expressed as SD) were used to standardize symptom assessments that were not uniform across studies. Random effects model was used to analyze data and meta-regression was used to evaluate the association between change in GE and UGI symptoms.
Of 899 studies considered, 22 studies assessed change in GE; 23 evaluated UGI symptoms; and 14 evaluated GE and UGI symptoms. Promotility agents significantly accelerated GE (T) in all studies (mean reduction in T, 16.3 minutes; 95% confidence interval, -22.1 to -10.6 minutes) and in studies that used optimal GE test methods (mean reduction in T, 23.6 minutes; 95% confidence interval, -32.3 to -14.9 minutes). Promotility agents also significantly reduced UGI symptoms (mean reduction, 0.25 SD; 95% confidence interval, -0.37 to -0.13 SD). Meta-regression found no significant association between change in GE and UGI symptoms. However, when only studies with optimal GE test methods were evaluated, there was a significant positive association between improvement in GE and UGI symptoms (P = .02).
In a meta-analysis of published trials, we found promotility agents to significantly accelerate GE (when optimal test methods were used) and to produce significant improvements in UGI symptoms.
研究报告称，胃排空（GE）改善与上消化道（UGI）症状与促动力药物之间缺乏关联。然而，在一些研究中，GE 测试方法并不理想。我们评估了在使用最佳或中等测试方法（闪烁扫描或呼吸测试、固体餐、>2 小时持续时间）的研究中，与使用不理想的 GE 测试方法的研究相比，给予促动力药物的患者的 GE 和 UGI 症状的改善情况。
我们与一位专家图书管理员一起，在 Ovid MEDLINE（1946 年至今）、EMBASE（1988 年至 2018 年 1 月）和 EBM Reviews Cochrane 对照试验中心注册库中进行了广泛的文献搜索，对语言和年份没有限制。两名独立评审员评估了以下纳入标准：5HT 激动剂、D 受体拮抗剂或 ghrelin 激动剂的随机、双盲、平行或交叉试验；测量 GE（T）变化或复合 UGI 症状变化的试验；功能性消化不良和胃轻瘫患者的试验；以及 GE 测试方法的试验。使用标准化均数差（单位表示为 SD）来标准化在研究之间不一致的症状评估。使用随机效应模型分析数据，并进行元回归以评估 GE 变化与 UGI 症状之间的关联。
在考虑的 899 项研究中，有 22 项研究评估了 GE 的变化；23 项评估了 UGI 症状；14 项评估了 GE 和 UGI 症状。促动力药物在所有研究中均显著加速了 GE（T）（T 的平均减少量为 16.3 分钟；95%置信区间，-22.1 至-10.6 分钟），并在使用最佳 GE 测试方法的研究中（T 的平均减少量为 23.6 分钟；95%置信区间，-32.3 至-14.9 分钟）。促动力药物还显著减少了 UGI 症状（平均减少 0.25 SD；95%置信区间，-0.37 至-0.13 SD）。元回归发现 GE 变化与 UGI 症状之间没有显著关联。然而，当仅评估使用最佳 GE 测试方法的研究时，GE 改善与 UGI 症状之间存在显著的正相关关系（P =.02）。
在对已发表试验的荟萃分析中，我们发现促动力药物可显著加速 GE（在使用最佳测试方法时），并显著改善 UGI 症状。
