Meta-analysis of the effects of prokinetic agents in patients with functional dyspepsia.
BACKGROUND
Functional dyspepsia (FD) is often treated with prokinetic agents; however, the efficacy of prokinetic agents in patients with FD has been questioned recently. The aim of this study was to perform a meta-analysis of the effects of prokinetic agents in patients with FD.


METHODS
Prokinetic agents, including metoclopramide, domperidone, trimebutine, cisapride, itopride and mosapride, used for treatment of FD between 1951 and 2005 were identified. Twenty-seven studies were selected. Difference in the probability of response between the interventional drug and placebo was used as a summary statistic for the treatment effect. Meta-regression analysis was used to detect sources of heterogeneity.


RESULTS
In total, 1844 subjects were assigned to an experimental arm, and 1591 subjects were assigned to a placebo arm. Publication bias was ruled out by funnel plot and statistical testing (P = 0.975). In the overall analysis, the summary statistic was 0.295 (95% confidence interval: 0.208-0.382, P < 0.001), indicating that the interventional drug has 30% excess probability of producing a response compared with placebo. The most significant source of heterogeneity was the year of publication (P < 0.001).


CONCLUSIONS
The data clearly indicate that prokinetic agents are significantly more effective than placebo in the treatment of FD. Although FD is a chronic condition, efficacy was assessed over short periods. Long-term randomized controlled trials are needed to confirm the effect.
Hiyama
Toru
T
Health Service Center, Hiroshima University, Higashihiroshima, Japan. tohiyama@hiroshima-u.ac.jp
Yoshihara
Masaharu
M
Matsuo
Keitaro
K
Kusunoki
Hiroaki
H
Kamada
Tomoari
T
Ito
Masanori
M
Tanaka
Shinji
S
Nishi
Nobuo
N
Chayama
Kazuaki
K
Haruma
Ken
K
D001549:Benzamides / Q000627:therapeutic use; D001593:Benzyl Compounds / Q000627:therapeutic use; D020117:Cisapride / Q000627:therapeutic use; D004294:Domperidone / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D004415:Dyspepsia / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D009025:Morpholines / Q000627:therapeutic use; D014287:Trimebutine / Q000627:therapeutic use
D001549:Benzamides; D001593:Benzyl Compounds; D018492:Dopamine Antagonists; D005765:Gastrointestinal Agents; D009025:Morpholines; D004294:Domperidone; C102254:itopride; C062720:mosapride; D008787:Metoclopramide; D014287:Trimebutine; D020117:Cisapride