Tom 16 (2024): Continuous Publishing
Artykuł przeglądowy
Opublikowany online: 2025-02-26
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Zapobieganie ostremu zapaleniu uchyłków. Czy stosowanie antybiotyków niewchłanialnych ma znaczenie? W poszukiwaniu dowodów: przegląd systematyczny, metaanaliza i analiza sekwencyjna badań
Gastroenterologia Kliniczna 2024;16(1):114-129.
Streszczenie
Wstęp: Liczba hospitalizacji z powodu zapalenia uchyłków jelita grubego, będących powikłaniem choroby uchyłkowej, znacznie się zwiększa. Zapobieganie zapaleniu uchyłków może obniżyć koszty leczenia i uratować życie chorym.
Cel badania: określenie możliwości zmniejszenia ryzyka wystąpienia pierwszego epizodu (profilaktyka pierwotna) lub nawrotu (profilaktyka wtórna) zapalenia uchyłków jelita grubego u pacjentów z chorobą uchyłkową po zastosowaniu niewchłanialnych antybiotyków (głównie ryfaksyminy).
Metody: Badania zidentyfikowano na podstawie przeszukania baz piśmiennictwa PubMed i CENTRAL od 1990 roku do maja 2022 roku. Oceniono także jakość metodologiczną każdego badania. Punktem końcowym metaanalizy było wystąpienie pierwszego lub kolejnego epizodu zapalenia uchyłków. W celu oceny wpływu na wyniki błędów typu I lub II przeprowadzono też analizę sekwencyjną badań.
Wyniki: Profilaktyka pierwotna: wykazano statystycznie istotną różnicę na korzyść ryfaksaminy (−0,019, lub −1,9%, CI −0,6 do −3,3%). Nie uzyskano dowodów na heterogeniczność (I2 0%). Po roku, dwóch i ośmiu latach NNT wyniosła odpowiednio 62, 52 i 42. Jakość dowodów była umiarkowana. Profilaktyka wtórna: wykazano statystycznie istotną różnicę na korzyść ryfaksaminy (−0,24, lub −24%, CI −47 do −2%). Uzyskano dowody na heterogeniczność (I2 92%); NNT wyniosła 5. Jakość dowodów była niska.
Podsumowanie: Ryfaksymina może obniżyć ryzyko pierwszego epizodu zapalenia uchyłków, jednak stosunek kosztów do korzyści wydaje się obecnie zbyt wysoki. Ryfaksymina może również obniżyć ryzyko drugiego epizodu, ale jakość dowodów wskazujących na to działanie jest niska. Rejestracja przeglądu systematycznego: https:// www.crd.york.ac.uk/prospero/, numer identyfikacyjny CRD42022379258.
Słowa kluczowe: choroba uchyłkowametaanalizaantybiotyki niewchłanialnezapalenie uchyłkówsekwencja badań
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