Meta AnalysisID 2957
异山梨酯与硝苯地平治疗慢性恰加斯病消化型患者贲门失弛缓症的系统评价
CRD42017055143
To evaluate the effect of isosorbide in gastrointestinal symptoms of chagasic patients. To evaluate the effect of nifedipine in gastrointestinal symptoms of chagasic patients.
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Record Fields
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- Meta Analysis Id
- 2957
- Evidence Id
- 11515
- Core Evidence Id
- 11515
- Source Meta Analysis Id
- 2906
- Herb2 Meta Analysis Id
- HBMA002906
- Crd Id
- CRD42017055143
- Title
- Isosorbide and nifedipine for treatment of achalasia in patients with digestive clinical form of chronic Chagas disease: a systematic review
- Review Question
- To evaluate the effect of isosorbide in gastrointestinal symptoms of chagasic patients. To evaluate the effect of nifedipine in gastrointestinal symptoms of chagasic patients.
- Study Type Included
- Observational investigations (cohort studies or case series), clinical trials and randomized clinical trials will be included.We will exclude experimental studies, case-control studies, cross-sectional studies, systematic reviews and meta-analyses, letters, and editorials.
- Condition Being Studied
- Chagas disease, also known as American trypanosomiasis, is a zoonosis that affects about 8–12 million people in Latin America (1). It is estimated that some 40 million people are at risk of acquiring the infection (2). Approximately 30% of infected people develop medical problems from Chagas disease over the course of their lives, usually several years or even decades after the initial infection. Chagas disease mainly affects the heart, nervous system and digestive system (3). Gastrointestinal manifestations are the second most common cause of complications due to Chagas disease. Approximately one third of patients can develop gastrointestinal motor disorders, such as achalasia of the cardia, disturbances of gastric emptying, altered intestinal transit and colon and gallbladder motor disorders (4,5). There are no specific treatments capable of restoring esophageal function, though partial recovery of esophageal peristalsis can be observed following clinical, endoscopic or surgical management (6). The treatment with isosorbide and nifedipine induce sphincter pressure relaxation and can be used in some cases. However, these treatments are not always effective and side effects are frequent (7). In patients with Chagasic achalasia, isosorbide dinitrate has shown to reduce lower esophageal sphincter pressure (8) improve esophageal emptying (9) and to relieve dysphagia (6). However, the beneficial effect of isosorbide dinitrate for patients with Chagasic achalasia was often impaired by headache as a common side effect (10). Sublingual nifedipine, calcium channel blocker, also decreases lower esophageal sphincter pressure in patients with Chagasic achalasia (11). The use of these therapies is doubtful, since it is considered a palliative treatment and followed by side effects. Based on this, it is necessary to systematically review the effects of isosorbide and nifedipine in gastrointestinal symptoms of chagasic patients. 1.Pan American Health Organization, WHO Department of Control of Neglected Tropical Diseases. Estimaci´on cuantitativa de la enfermedad de Chagas en las Americas. Montevideo, Uruguay 2006. OPS/HDM/CD/22506. 2. Schofield C, Jannin J, Salvatella R. The future of Chagas disease control. Trends Parasitol. 2006; 22:583–8. 3. Bern C., et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007; 298:2171-81 4. Dantas RO, Godoy RA. The lower esophageal sphincter in patients with Chagas disease with peristalsis and aperistalsis. Arq Gastroenterol. 1983; 20:13-6. 5. Oliveira RB, Troncon LE, Dantas RO, Menghelli UG. Gastrointestinal manifestations of Chagas disease. Am J Gastroenterol. 1998; 93:884-9. 6. Pinazzo MJ, et al. Diagnosis, management and treatment of chronic Chagas' gastrointestinal disease in areas where Trypanosoma cruzi infection is not endemic. Gastroenterol Hepatol. 2010 Mar;33(3):191-200 7. Oliveira RB, Rezende Filho J, Dantas RO, Iazigi N. The spectrum of oesophageal motor disorders in Chagas disease. Am J Gastroentero. 1995; 90:1119–24. 8.Dantas R 0, Godoy R A, Oliveira R B, et al. Effect of isosorbide dinitrate and atropine on the lower esophageal sphincter pressure in chagasic patients. Acta Physiol Pharmacol Latinoam 1988; 38: 151-8. 9. Rezende Filho J, Oliveira R B, Dantas R 0, et al. Efeito do dinitrato de isossorbitol sobre o esvaziamento esofagiano no megaesbfago chagdsico. SZo Paulo Arq Gastroenterol 1990; 27: 115-9. 10. Ferreira Filho L P, Patto R J, Troncon L E A, et al. Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas' disease achalasia. A double-blind, crossover trial. Brazilian J Med Biol Res 1991; 24: 1093-98. 11. Dantas R 0, Godoy R A, Villanova M G, et a1. Effect of nifedipine on the lower esophageal sphincter pressure in chagasic patients. Brazilian J Med Biol Res 1986; 19: 205-9.
- Participant
- Adults (> 18 years old) affected by gastrointestinal Chagas disease.
- Animal
- Human Disease Modelled
- Intervention
- We will include studies regarding the use of isosorbide or nifedipine to treat gastrointestinal symptoms in patients affected by gastrointestinal Chagas disease.
- Comparator Control
- The comparator groups will be placebo group, standard care, no intervention, or different treatment drugs.
- Main Outcome
- The primary outcome will be improvement of gastrointestinal symptoms. Measures of effect Assessed by sphincter pressure, with a reduction in dysphagia, gastroesophageal emptying and gastroesophageal reflux.
- Outcome Measure
- Additional Outcome
- The secondary outcome will be adverse effects of the treatments. Measures of effect Incidence the adverse effects.
- Study Method
- Systematic review
- Keyword
- Chagas Disease; Esophageal Achalasia; Humans; Isosorbide; Isosorbide Dinitrate; Nifedipine
- Contact
- Cinara Stein [email protected]
- Organisational Affiliation
- Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil www.hospitalmoinhosdevento.org.br
- Funding Source
- Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS). Brazilian Ministry of Health
- Other Selection Criteria
- Final Publication
- Celina Borges Migliavaca, Cinara Stein, Verônica Colpani, Sandro René Pinto de Sousa Miguel, Luciane Nascimento Cruz, Roberto Oliveira Dantas, Maicon Falavigna. Isosorbide and nifedipine for Chagas' megaesophagus: A systematic review and meta-analysis. PLOS One. Published: September 28, 2018. https://doi.org/10.1371/journal.pntd.0006836 https://doi.org/10.1371/journal.pntd.0006836
- Same Topic Review
- Published Protocol
- Review Type
- Language
- English
- Country
- Brazil
- Review Stage
- Review Completed published
- First Submission Date
- 2018-10-08
- Registration Date
- 2017-01-11
- Anticipated Start Date
- 2017-01-11
- Anticipated Completion Date
- 2017-04-28
- Title Cn
- 异山梨酯与硝苯地平治疗慢性恰加斯病消化型患者贲门失弛缓症的系统评价
- Title En
- Isosorbide and nifedipine for treatment of achalasia in patients with digestive clinical form of chronic Chagas disease: a systematic review
- Bilingual Status
- complete