Article type
Abstract
"Background: Inflammatory Bowel Disease (IBD) is a disease that includes periods with flare-ups and quieter periods in remission. Patients with IBD can have different pain conditions that require treatment. When paracetamol is not effective enough, the alternatives are opioids or NSAIDs. There are clinical concerns of physical dependence and addiction with opioids. On the other hand, there are concerns that NSAID may increase the risk of IBD flare-ups, which would be a serious side effect.
Objectives: To assess if the risk of IBD-flare-ups is affected by the use of NSAID.
Methods: We conducted a systematic review according to Cochrane methods. Searches were performed in 3 databases (PubMed, Cochrane och Embase) up to March 31 2023. The results from included studies were synthesized using Synthesis Without Meta-analysis (SWiM) and the certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).
Results: We identified 5 relevant studies, of which 2 were assessed as having critical risk of bias and were not included in the synthesis. Given the scarce number of studies and the diversity of study designs (1 RCT, 1 case-control, 1 cohort study), synthesis of results was a challenging task. However, using SWiM we were able to show that: A shorter course of NSAIDs for individuals with well-controlled IBD and thus a low risk of flare-ups may have little to no effect on the risk of flare-ups. At a higher baseline risk, the results were more uncertain and a potential increase in risk could be clinically significant.
Conclusions: Using SWiM provided a structured way of synthesizing the studies although they had very different study designs. The estimation of the absolute risk of IBD flare-ups enables clinicians and patients to make informed decisions even if results are uncertain."
Objectives: To assess if the risk of IBD-flare-ups is affected by the use of NSAID.
Methods: We conducted a systematic review according to Cochrane methods. Searches were performed in 3 databases (PubMed, Cochrane och Embase) up to March 31 2023. The results from included studies were synthesized using Synthesis Without Meta-analysis (SWiM) and the certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations).
Results: We identified 5 relevant studies, of which 2 were assessed as having critical risk of bias and were not included in the synthesis. Given the scarce number of studies and the diversity of study designs (1 RCT, 1 case-control, 1 cohort study), synthesis of results was a challenging task. However, using SWiM we were able to show that: A shorter course of NSAIDs for individuals with well-controlled IBD and thus a low risk of flare-ups may have little to no effect on the risk of flare-ups. At a higher baseline risk, the results were more uncertain and a potential increase in risk could be clinically significant.
Conclusions: Using SWiM provided a structured way of synthesizing the studies although they had very different study designs. The estimation of the absolute risk of IBD flare-ups enables clinicians and patients to make informed decisions even if results are uncertain."