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Effect of mesalazine on recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease: a meta‐analysis with trial sequential analysis of randomized controlled trials
Author(s) -
Khan R. M. A.,
Ali B.,
Hajibandeh S.,
Hajibandeh S.
Publication year - 2018
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14064
Subject(s) - mesalazine , medicine , diverticulitis , randomized controlled trial , diverticular disease , meta analysis , placebo , gastroenterology , relative risk , surgery , disease , confidence interval , inflammatory bowel disease , pathology , alternative medicine
Abstract Aim he aim was to investigate the effect of mesalazine on the recurrence of diverticulitis in patients with symptomatic uncomplicated diverticular disease ( SUDD ). Methods We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials ( RCT s) investigating the effect of mesalazine on the recurrence of diverticulitis in patients with SUDD . We used the Cochrane tool to assess the quality of included studies. Random effects models were applied to calculate pooled outcome data. Trial sequential analysis was performed to assess the possibility of type I or II errors and to compute the information size required for conclusive meta‐analysis. Results We identified six RCT s which enrolled a total of 1918 patients. There was no difference in the recurrence of diverticulitis between the mesalazine and placebo groups ( OR 1.20, 95% CI 0.96–1.50, P = 0.11). A low level of heterogeneity among the studies existed ( I 2 = 9%, P = 0.36). When the mesalazine dose was ≤ 2 g/day, there was no difference in recurrence rate between the two groups ( OR 1.10, 95% CI 0.79–1.54, P = 0.58). When the mesalazine dose was > 2 g/day, the risk of recurrence was higher in the mesalazine group ( OR 1.28, 95% CI 1.02–1.62, P = 0.04). The information size was calculated as 2461 patients. Trial sequential analysis showed that the meta‐analysis was conclusive and the risk of type II error was minimal. Conclusions Mesalazine does not prevent the recurrence of diverticulitis in patients with SUDD . Further studies are required to investigate the role of mesalazine as an adjunct to other medical agents in the prevention of diverticulitis in patients with SUDD .