PMID- 31727037 OWN - NLM STAT- MEDLINE DCOM- 20200128 LR - 20231019 IS - 1472-6882 (Electronic) IS - 1472-6882 (Linking) VI - 19 IP - 1 DP - 2019 Nov 14 TI - Comparative efficacy of pharmacological and nonpharmacological treatments for chronic idiopathic constipation in China: a Bayesian network meta-analysis. PG - 311 LID - 10.1186/s12906-019-2741-z [doi] LID - 311 AB - BACKGROUND: To provide evidence for medical management of chronic idiopathic constipation (CIC) in China based on comparisons of all clinical practical interventions using Bayesian network meta-analysis. METHODS: We conducted a systematic literature review by searching PubMed, Embase, Cochrane Central, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database (inception to May 2019) for randomized controlled trials (RCTs) for CIC in Chinese people. Only RCTs that recruited participants aged over 18 and diagnosed with CIC by the Rome II, III or IV criteria were included. We used three outcomes to examine efficacy. The risk ratio (RR) of the responder rate, based on >/=3 spontaneous bowel movements (SBMs) per week after treatment, was the primary outcome, and the SBM count per week and the Bristol score (BS) were secondary outcomes. In addition, adverse effects (AEs) were also considered a secondary outcome to evaluate safety. We conducted Bayesian network meta-analysis with random effects, and the RR or mean difference with its 95% credible interval was calculated. In addition, we ranked all treatments via their cumulative curves (SUCRA) and assessed the quality of evidence according to the GRADE criteria. RESULTS: We included a total of 42 trials (6820 participants) of 20 grouped interventions that included pharmacological and nonpharmacological treatments. For the primary outcome, fourteen interventions were significantly better than placebo, and Probiotics plus Mosapride (PB + MP) appeared superior to others (GRADE quality of evidence: Moderate to Low), followed by Prucalopride (PP) (High to Low) and Electroacupuncture (EA) (High to Low). For SBM, Compound sodium bicarbonate suppository (CSBS) appeared to be best, with an SUCRA value of 90% (High to Low). For BS, Lactulose plus Probiotics (LT + PB) was superior to others (Moderate to Low), followed by Polyethylene glycol (PEG) (High to Moderate). Although all interventions appeared non-significant when compared with placebo in terms of adverse effects, Lactulose plus Mosapride showed greater risk than others on ranking probability. CONCLUSIONS: Given the GRADE assessment, PB + MP, PP and EA may be the priory options with moderate certainty in the quality of evidence for the primary outcome. For SBM, a CSBS may be the best option with moderate certainty in the quality of evidence. For BS, PEG may be the priory option with high certainty in the quality of evidence. However, due to a lack of high certainty in the quality of evidence, caution is needed when recommending the interventions. Because of the limitations, an increased number of trials are required for more accurate results. FAU - Shi, Qingyang AU - Shi Q AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. FAU - Tan, Lizi AU - Tan L AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. FAU - Liu, Chunxiang AU - Liu C AUID- ORCID: 0000-0003-4063-3729 AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. liuchunxiangebm@foxmail.com. AD - Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China. liuchunxiangebm@foxmail.com. FAU - Wang, Huijun AU - Wang H AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. whj-002@163.com. FAU - Zhang, Junhua AU - Zhang J AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. AD - Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China. FAU - Wang, Hui AU - Wang H AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. AD - Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China. FAU - Zhai, Jingbo AU - Zhai J AD - Tianjin University of Traditional Chinese Medicine, Beihua south road, Jinghai district, Tianjin, 301617, China. AD - Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China. LA - eng GR - 18JCTPJC64900/Tianjin enterprise science and technology commissioner project/ GR - 81804218/National Natural Science Foundation of China (CN)/ GR - TD13-5047/Training Program of Innovation Team of Tianjin Higher Education Institution/ PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20191114 PL - England TA - BMC Complement Altern Med JT - BMC complementary and alternative medicine JID - 101088661 RN - 0 (Suppositories) RN - 3WJQ0SDW1A (Polyethylene Glycols) SB - IM MH - Bayes Theorem MH - China MH - Constipation/*drug therapy/physiopathology MH - Defecation/drug effects MH - Humans MH - Polyethylene Glycols/therapeutic use MH - Probiotics/therapeutic use MH - Randomized Controlled Trials as Topic MH - Suppositories/therapeutic use PMC - PMC6857160 COIS- The authors declare that they have no competing interests. EDAT- 2019/11/16 06:00 MHDA- 2020/01/29 06:00 PMCR- 2019/11/14 CRDT- 2019/11/16 06:00 PHST- 2019/02/28 00:00 [received] PHST- 2019/11/04 00:00 [accepted] PHST- 2019/11/16 06:00 [entrez] PHST- 2019/11/16 06:00 [pubmed] PHST- 2020/01/29 06:00 [medline] PHST- 2019/11/14 00:00 [pmc-release] AID - 10.1186/s12906-019-2741-z [pii] AID - 2741 [pii] AID - 10.1186/s12906-019-2741-z [doi] PST - epublish SO - BMC Complement Altern Med. 2019 Nov 14;19(1):311. doi: 10.1186/s12906-019-2741-z.