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Toews I, Hussain S, Nyirenda JLZ, Willis MA, Kantorová L, Slezáková S, Boltena MT, Victor PJ, Fontes LES, Klugar M, Sadeghirad B, Meerpohl JJ. Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis. BMJ Evid Based Med 2024:bmjebm-2024-112886. [PMID: 38997152 DOI: 10.1136/bmjebm-2024-112886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs). DESIGN AND SETTING Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. PARTICIPANTS Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included. SEARCH METHODS The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). MAIN OUTCOME MEASURES The primary outcome was the prevention of clinically important upper GI bleeding. RESULTS We included 123 studies with 46 996 participants. Cimetidine (relative risk (RR) 0.56, 95% CI 0.40 to 0.77, moderate certainty), ranitidine (RR 0.54, 95% CI 0.38 to 0.76, moderate certainty), antacids (RR 0.48, 95% CI 0.33 to 0.68, moderate certainty), sucralfate (RR 0.54, 95% CI 0.39 to 0.75, moderate certainty) and a combination of ranitidine and antacids (RR 0.13, 95% CI 0.03 to 0.62, moderate certainty) are likely effective in preventing upper GI bleeding.The effect of any intervention on the prevention of nosocomial pneumonia, all-cause mortality in the ICU or the hospital, duration of the stay in the ICU, duration of intubation and (serious) adverse events remains unclear. CONCLUSIONS Several interventions seem effective in preventing clinically important upper GI bleeding while there is limited evidence for other outcomes. Patient-relevant benefits and harms need to be assessed under consideration of the patients' underlying conditions.
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Affiliation(s)
- Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - John L Z Nyirenda
- Institute for Evidence in Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Maria A Willis
- Department of General, Visceral, Thorax and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Lucia Kantorová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simona Slezáková
- Cochrane Czech Republic, Czech Republic: a JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Center, Institute of Health, A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Peter John Victor
- Medical Intensive Care Unit, Christian Medical College & Hospital, Vellore, India
| | | | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Center of Evidence-Based Education and Arts Therapies: A JBI Affiliated Group, Palacky University Olomouc Faculty of Education, Olomouc, Olomoucký, Czech Republic
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Kumaria A, Kirkman MA, Scott RA, Dow GR, Leggate AJ, Macarthur DC, Ingale HA, Smith SJ, Basu S. A Reappraisal of the Pathophysiology of Cushing Ulcer: A Narrative Review. J Neurosurg Anesthesiol 2024; 36:211-217. [PMID: 37188653 DOI: 10.1097/ana.0000000000000918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/21/2023] [Indexed: 05/17/2023]
Abstract
In 1932, Harvey Cushing described peptic ulceration secondary to raised intracranial pressure and attributed this to vagal overactivity, causing excess gastric acid secretion. Cushing ulcer remains a cause of morbidity in patients, albeit one that is preventable. This narrative review evaluates the evidence pertaining to the pathophysiology of neurogenic peptic ulceration. Review of the literature suggests that the pathophysiology of Cushing ulcer may extend beyond vagal mechanisms for several reasons: (1) clinical and experimental studies have shown only a modest increase in gastric acid secretion in head-injured patients; (2) increased vagal tone is found in only a minority of cases of intracranial hypertension, most of which are related to catastrophic, nonsurvivable brain injury; (3) direct stimulation of the vagus nerve does not cause peptic ulceration, and; (4) Cushing ulcer can occur after acute ischemic stroke, but only a minority of strokes are associated with raised intracranial pressure and/or increased vagal tone. The 2005 Nobel Prize in Medicine honored the discovery that bacteria play key roles in the pathogenesis of peptic ulcer disease. Brain injury results in widespread changes in the gut microbiome in addition to gastrointestinal inflammation, including systemic upregulation of proinflammatory cytokines. Alternations in the gut microbiome in patients with severe traumatic brain injury include colonization with commensal flora associated with peptic ulceration. The brain-gut-microbiome axis integrates the central nervous system, the enteric nervous system, and the immune system. Following the review of the literature, we propose a novel hypothesis that neurogenic peptic ulcer may be associated with alterations in the gut microbiome, resulting in gastrointestinal inflammation leading to ulceration.
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Affiliation(s)
| | | | - Robert A Scott
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust
- Nottingham Digestive Diseases Centre
| | - Graham R Dow
- Department of Neurosurgery, Queen's Medical Centre
| | | | | | | | - Stuart J Smith
- Department of Neurosurgery, Queen's Medical Centre
- Children's Brain Tumour Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Surajit Basu
- Department of Neurosurgery, Queen's Medical Centre
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Alhujilan SS, Saeed MS, Abdulaziz Alalwan A. Assessment of adherence to the national stress ulcer prophylaxis guidelines: A cross-sectional analysis. Saudi Pharm J 2023; 31:101754. [PMID: 37680755 PMCID: PMC10480312 DOI: 10.1016/j.jsps.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Background Clinical guidelines support the use of stress ulcer prophylaxis (SUP) in patients at risk of gastrointestinal (GI) bleeding such as those with coagulopathy, renal replacement therapy, and mechanical ventilation. Despite the observed benefits of SUP, its overuse has been highly associated with serious adverse effects. Objective To assess the adherence to the national SUP guidelines in a tertiary hospital in Saudi Arabia. Methods A cross-sectional study was conducted using electronic health records at King Fahad Specialist Hospital (KFSH), Buraydah, Saudi Arabia. We collected the data from January 1st to December 31st, 2020. Adult patients aged 18 and older who received SUP prescriptions were included. Descriptive analysis was performed to assess the adherence to the guidelines and to explore the factors associated with SUP use in a hospital-based setting. Results A total of 424 patients were enrolled in this study. The median age of patients was 55.2 years old. Only 54% of patients were candidates for SUP. Internal medicine and surgery wards ranked the highest in prescribing SUP at 34.2% and 30.4%, respectively. The most common major criterion to start SUP was the concomitant use of two or more of these medications (anticoagulants, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and antidepressants) followed by using NSAIDs or corticosteroids by older adult patients aged (≥65 years) or have GI bleeding history at 43.2% and 21.5%, respectively. Conclusion The observed overuse of anti-ulcer drugs (AUD) indicates a need for greater adherence to SUP guidelines. Areas of improvement can be implemented to ensure appropriate adherence to SUP guidelines to control the costs and avoid unnecessary anti-ulcer-related adverse effects.
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Affiliation(s)
| | - Mustafa S Saeed
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia
| | - Abdullah Abdulaziz Alalwan
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
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Huang M, Han M, Song Z, Kuang L. Stress Ulcer Prophylaxis in Critically Ill Adult Patients with Sepsis at Risk of Gastrointestinal Bleeding: A Retrospective Cohort Study. Intern Med J 2021; 53:389-396. [PMID: 34697866 DOI: 10.1111/imj.15598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/24/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Surviving Sepsis Campaign Guidelines recommend stress ulcer prophylaxis (SUP) for patients with sepsis who have gastrointestinal (GI) bleeding risks, however, the effect of SUP has not been specially studied in these patients. AIMS The purpose of this study is to determine the effects of SUP versus no prophylaxis on patient-important outcomes in critically ill adult patients with sepsis who have risk factors for GI bleeding. METHODS This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care III database. We compared those who received SUP with proton pump inhibitors or histamine-2 receptor antagonists for ≥3 days with those who received no prophylaxis. Propensity score matching (PSM) was conducted to make comparisons between groups with similar distributions of study variables. The primary outcome was in-hospital mortality. RESULTS A total of 7,744 patients were included in the analysis, with 1,088 (14.0%) in the non-SUP group and 6,656 (86.0%) in the SUP group. A 1:1 PSM created 866 patients in each cohort. No significant differences were noted between the two groups with regard to in-hospital mortality (22.3%vs.20.4%, p=0.379), GI bleeding (4.7%vs.6.4%, p=0.172), pneumonia(38.9%vs.36.6%,p=0.346), Clostridium difficile infection(6.4% vs. 8.9%, p=0.0.057), or ICU length of stay (LOS) (4.2 d vs. 4.6 d, p=0.394). CONCLUSIONS Among critically ill, septic, adult patients at risk for gastrointestinal bleeding, stress ulcer prophylaxis showed no effect on hospital mortality, the rate of GI bleeding, pneumonia, CDI, and ICU LOS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Minqiang Huang
- Department of Emergency intensive care unit, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Ming Han
- Department of Emergency department, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Zhi Song
- Department of General Intensive Care Unit, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Lei Kuang
- Department of Research and Teaching, Shenzhen University General Hospital, Shenzhen, Guangdong, China
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Granholm A, Krag M, Marker S, Alhazzani W, Perner A, Møller MH. Predictors of gastrointestinal bleeding in adult ICU patients in the SUP-ICU trial. Acta Anaesthesiol Scand 2021; 65:792-800. [PMID: 33635540 DOI: 10.1111/aas.13805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/10/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND In previous studies of predictors of gastrointestinal (GI) bleeding in the intensive care unit (ICU), most patients received pharmacological stress ulcer prophylaxis (SUP). We aimed to assess associations between potential predictors of clinically important GI bleeding (CIB) and overt GI bleeding in adult ICU patients, while considering the effect and potential interaction with use of SUP. METHODS We included 3291 acutely admitted adult ICU patients with risk factors for GI bleeding randomized to SUP (pantoprazole) or placebo in the SUP-ICU trial. We used logistic regression models adjusted for allocation to SUP to estimate associations between 23 potential predictors and CIB (primary outcome) and overt GI bleeding (secondary outcome). Furthermore, we assessed associations between potential predictors and both outcomes in each allocation group and assessed potential interaction with allocation to SUP. RESULTS Increasing SAPS II and SOFA scores, use of circulatory support and renal replacement therapy were associated with increased risk of CIB and overt GI bleeding; chronic lung disease was associated with increased risk of overt GI bleeding. Results for the remaining potential predictors were compatible with both no difference or increased and decreased risks. We found no strong evidence for any interaction between treatment allocation and any potential predictors. CONCLUSION In adult ICU patients at risk of GI bleeding, severity of illness, use of circulatory support and renal replacement therapy were associated with higher odds of CIB, with no strong evidence of interaction with SUP.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Mette Krag
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care Copenhagen Denmark
| | - Søren Marker
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care Copenhagen Denmark
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Canada
- Department of Medicine, Division of Critical Care McMaster University Hamilton Canada
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care Copenhagen Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care Copenhagen Denmark
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Ni X, Lin M, Li J, Zeng L, Li W, Huang L, Li D, Zhang L. Development of an evaluation indicator system for the rational use of proton pump inhibitors in pediatric intensive care units: An application of Delphi method. Medicine (Baltimore) 2021; 100:e26327. [PMID: 34128875 PMCID: PMC8213291 DOI: 10.1097/md.0000000000026327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
Proton pump inhibitors are frequently used to prevent gastrointestinal bleeding in critically ill patients. But there is little information in the instructions about the usages for children. It is important to monitor the appropriate use of proton pump inhibitors, especially in pediatrics. Therefore, we developed an evaluation indicator system for the rational use of proton pump inhibitors in pediatric intensive care units.First, a systematic review was conducted to developed the initial indicators. Then 2 rounds of Delphi surveys were conducted to collecting opinions from a panel of independent experts, and the indicator system was modified to form the final indicators according to the opinions. Finally, the analytic hierarchy procedure was used to determine the weight of each indicator.A total of 6 guidelines and 2 studies met the inclusion and exclusion criteria. Based on literature and discussion among experts, an initial indicator system including 4 first-rank indicators and 12 second-rank indicators was formed. After 2 rounds of Delphi surveys, 2 indicators were added, 5 indicators were deleted, and 1 indicator was revised, so the final indicator system contained a total of 13 indicators including 3 first-rank indicators (drug selection, drug usage and dosage, duration of drug therapy) and 10 second-rank indicators (the proportion of PPIs used in children, children under 1 year old, children who is using glucocorticoids, children with nonsteroidal anti-inflammatory drugs, children with gastroesophageal reflux disease, children with sepsis, children with ventilators in PICU; the strength of PPIs' use, the proportion of omeprazole in children using PPIs during the same period; the average days of PPIs used in children). By analyzing scores, all coefficients met the standard, indicating the indicators were scientific and credible.Through a two-round Delphi survey, 3 first-rank indicators and ten second-rank indicators were developed, which will help drug administrative departments to promote the rational use of PPIs for children in PICUs. What is more, our study can constitute a methodological reference for the development of other indicator systems.
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Affiliation(s)
- Xiaofeng Ni
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Medicine, Sichuan University
| | - Mao Lin
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Jialian Li
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Linan Zeng
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Wenrui Li
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
| | - Liang Huang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
| | - Deyuan Li
- Pediatric intensive care, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University)
- West China School of Pharmacy, Sichuan University
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Zhang XY, Li T, Wu H, Ling Y, Qian ZP, Chen L. Analysis of the Effect of Proton-Pump Inhibitors on the Course of COVID-19. J Inflamm Res 2021; 14:287-298. [PMID: 33574690 PMCID: PMC7872926 DOI: 10.2147/jir.s292303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study is to evaluate the effect of proton-pump inhibitors on the course of COVID-19. METHODS Clinical data of moderate COVID-19 patients admitted to the Shanghai Public Health Clinical Center for treatment from January 20, 2020, to March 16, 2020, were collected. A retrospective study was conducted and the patients were divided into two groups according to whether they used proton-pump inhibitors or not. The differences in SARS-CoV-2 clearance and hospital stay between the two groups were compared by Cox proportional hazards (PH) regression models and the propensity score matching method. RESULTS A total of 154 patients with moderate COVID-19 were included in this study, including 80 males (51.9%), 35 patients (22.7%) in the proton-pump inhibitor group, and 119 patients (77.3%) in the control group. In the proton-pump inhibitor group and the control group, the duration of the SARS-CoV-2 clearance was 7 days (95% CI, 6-9) and 7 days (95% CI, 6-11), and the duration of the hospital stay was 21 days (95% CI, 16-25) and 20 days (95% CI, 15-26), respectively. There was no significant difference between the both groups in the cumulative incidence of the SARS-CoV-2 clearance and the discharge, and the same results were obtained after the propensity score matching, all P > 0.05. There was no significant association between the use of proton-pump inhibitors and the duration of SARS-CoV-2 clearance, according to univariate analysis (HR, 1.309; 95% CI, 0.893-1.918) and multivariate analysis (HR, 1.575; 95% CI, 0.993-2.499). There was no significant association between the use of proton-pump inhibitors and the duration of hospital stay for COVID-19, according to univariate analysis (HR, 1.044; 95% CI, 0.714-1.528) and multivariate analysis (HR, 1.064; 95% CI, 0.651-1.740). CONCLUSION The use of proton-pump inhibitors has no effect on prolonging or shortening the course of adults hospitalized with COVID-19.
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Affiliation(s)
- Xiao-Yu Zhang
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Tao Li
- Department of Tuberculosis Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Haibing Wu
- Department of Neurosurgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Zhi-Ping Qian
- Department of Severe Hepatopathy, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
| | - Liang Chen
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, People’s Republic of China
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Zang X, Sun M, Xian J, Yu H, Zhang X, Zhang C, Tan Q. Effects of acupuncture for nonalcoholic fatty liver disease: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23219. [PMID: 33217835 PMCID: PMC7676580 DOI: 10.1097/md.0000000000023219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, which may develop gradually into nonalcoholic steatohepatitis, liver fibrosis, and cirrhosis. As a classical method of traditional Chinese medicine, acupuncture has been used to treat NAFLD in clinical practice. However, there is no systematic review and meta-analysis of acupuncture on NAFLD. There is an urgent need to evaluate the clinical efficacy of acupuncture for NAFLD. METHODS We will perform a comprehensive retrieval in the following electronic databases: MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, PubMed, Science Citation Index Expanded (Web of Science), Epistemonikos, China National Knowledge Infrastructure (CNKI) database, Wanfang Data Knowledge Service Platform, Chinese Scientific Journals Database (VIP), Chinese Biomedical Literature Service System (SinoMed), and other databases from their inception to October 2020. We will select the qualified studies for data extraction and assess the quality and risk of bias, independently. The meta-analyses will be conducted by using the RevMan 5.3. RESULTS This study will provide a reliable basis for the treatment of NAFLD with acupuncture. CONCLUSION The findings will be an available reference to evaluate whether acupuncture is an effective intervention for patient with NAFLD. OSF REGISTRATION NUMBER 10.17605/OSF.IO/VFYXH.
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Affiliation(s)
| | - Mi Sun
- Shandong University of Traditional Chinese Medicine
| | - Jin Xian
- Shandong University of Traditional Chinese Medicine
| | - Huijuan Yu
- Shandong University of Traditional Chinese Medicine
| | - Xin Zhang
- Shandong University of Traditional Chinese Medicine
| | - Changyun Zhang
- Shandong Provincial Hospital of Traditional Chinese Medicine, Shandong, China
| | - Qiwen Tan
- Shandong University of Traditional Chinese Medicine
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