As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr P. Collins.
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Meta-analysis
Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic
Article first published online: 29 APR 2012
DOI: 10.1111/j.1365-2036.2012.05115.x
© 2012 Blackwell Publishing Ltd
Additional Information
How to Cite
Colli, A., Conte, D., Valle, S. D., Sciola, V. and Fraquelli, M. (2012), Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic. Alimentary Pharmacology & Therapeutics, 35: 1370–1378. doi: 10.1111/j.1365-2036.2012.05115.x
Publication History
- Issue published online: 14 MAY 2012
- Article first published online: 29 APR 2012
- Manuscript Accepted: 9 APR 2012
- Manuscript Revised: 7 APR 2012
- Manuscript Revised: 30 JAN 2012
- Manuscript Received: 12 JAN 2012
Summary
Background
Biliary colic is a common manifestation of cholelithiasis, developing in about one-third of patients. Even if nonsteroid anti-inflammatory drugs (NSAIDs) have widely been used to relieve biliary pain, there is a lack of systematic review of treatments on this issue.
Aim
To assess the potential benefits in terms of both pain control and reduction of complications, and the potential harms of NSAIDs in patients with biliary colic.
Methods
Data from randomised clinical trials (RCTs) comparing NSAIDs with no treatment, placebo or other drugs in patients with biliary colic, were collected from Medline and Embase. The outcome measures were expressed as odds ratio and relative risk and then pooled using fixed or random-effect models.
Results
Eleven RCTs involving 1076 subjects (268 men, 808 women; 18–86 years), including 442 controls were analysed. In comparison with placebo, NSAIDs led to a significantly higher proportion of patients with complete pain relief (RR 3.77, 95%CI 1.65–8.61; I2: 73%) and a significantly lower rate of complications (RR 0.53, 95% CI 0.31–0.89; I2: 35%). In comparison with other drugs, NSAIDs were more efficacious in controlling pain than spasmolytics (RR 1.47, 95% CI 1.03–2.10; I2: 55%); there was no difference between NSAIDs and opioids (RR 1.05, 95% CI 0.82–1.33; I2: 74%).
Conclusions
In patients with biliary colic NSAIDs are the first-choice treatments as they control pain with the same efficacy of opioids and significantly reduce the proportion of patients with severe complications. However, the lack of high-quality RCTs and the presence of consistent heterogeneity among studies may partially flaw these results.