Interventions for the Management of Abdominal Pain in Ulcerative Colitis
Sinopoulou V, Gordon M, Dovey TM., Akobeng AK. Interventions for the management of abdominal pain in ulcerative colitis. A systematic review Cochrane Database 2021, No. 7. Art. No.: CD013589. doi: 10.1002 /14651858.CD013589.pub2. Accessed July 28, 2021.
Commentary
This study was conducted to evaluate the efficacy and safety of an intervention to manage abdominal pain in ulcerative colitis.
The main results included five studies (360 randomized participants), and the studies primarily considered participants with an inactive state of the disease.
No conclusions could be drawn about the effectiveness of the interventions on pain frequency, pain intensity, or treatment success, and the certainty of evidence was very low for all comparisons because of the sparsity of data, imprecision, and risk of bias.
・One study compared a low FODMAP diet (n = 13) with a sham diet (n = 13).
Evidence for the effect of this treatment on pain frequency and intensity became very uncertain, and treatment success was not reported.
・Relaxation training (n = 20) was compared to a waiting list (n = 20).
Evidence for the effect of this treatment on pain frequency at the end of the intervention and on 6-month follow-up is very uncertain. Similarly, the evidence for the effect of this treatment on pain intensity at the end of the intervention and 6-month follow-up is highly uncertain, with no treatment success reported.
・Yoga (n = 30) was compared to no intervention (n = 30).
This study defined treatment success as the presence or absence of pain, but the data they provided became equivocal, and the frequency and intensity of pain was not reported.
・A kefir diet (Lactobacillus, n = 15) was compared to no intervention (n = 15).
Evidence for the effect of this treatment on pain intensity became very uncertain, and pain frequency and treatment success were not reported.
・A comparison was made between stellate ganglion block treatment (n = 90) and sulfasalazine treatment (n = 30). This study defined treatment success as "abdominal pain," but the data they provided was unclear and did not report the frequency and intensity of pain.
Two of these studies reported withdrawal due to adverse events. Two studies did not report this outcome and the evidence is so limited that no conclusions can be drawn about the impact of the intervention on withdrawal due to adverse events.
Reporting of secondary outcomes was inconsistent.
Adverse events tended to be very low or zero. However, due to the small number of events, it is not possible to make definite judgments about adverse events of the intervention.
The authors conclude that
They found very low certainty evidence on the efficacy and safety of interventions for the management of abdominal pain in ulcerative colitis, and that extensive problems with very serious imprecision due to small sample size and high risk of bias made the results very low certainty and inconclusive.
Few adverse events were reported, and no serious adverse events were reported, but the certainty of these findings was again very low for all comparisons, making them inconclusive.
Therefore, further studies are needed, and this review identified eight ongoing studies that need to be updated.
It is important that future studies address issues that lead to reduced certainty of results, particularly sample size and reporting that leads to a high risk of bias, and that if researchers view pain as a serious outcome, they need to clearly report whether participants were pain free at baseline.
If this is the case, the data is best presented as individual subgroups throughout the study.
