Da-cheng-qi decoction, a traditional Chinese herbal formula, for intestinal obstruction: systematic review and meta-analysis.

B Yang,F Xu,X Shi,L Tang,Z Zou,H Sun,C Ling

doi:10.4314/ajtcam.v11i4.17

Abstract

This study was aimed at determining the effects and safety of Da-Cheng-Qi decoction (DCQD) or DCQD combined with conservative therapy in patients with intestinal obstruction. PubMed, EMBASE, Cochrane Controlled Trials Register, and several other databases were searched. Randomised controlled trials (RCTs) of DCQD or DCQD plus conservative therapy in patients with intestinal obstruction were eligible. Therapeutic effect was estimated by the improvement of clinical manifestations and diagnostic imaging; dichotomous/ordinal data assessment of overall response to therapy, adverse effects; or continuous variable were identified, including time to first bowel movement, time to first flatus, length of hospital stay. Sixty eligible RCTs including 6,095 patients were identified. Response rate: (1) DCQD versus conservative therapy (6 RCTs, 361 patients, RR of respond =1.13; 95% CI 0.97 to 1.31). (2) DCQD plus conservative therapy versus conservative therapy (48 RCTs, 4,916 patients, RR of respond =1.25 which favoured DCQD plus conservative therapy; 95% CI 1.20 to 1.30). Treatment effect remained similar when RCTs at high risk of bias were excluded. Time to first flatus postoperatively: (1) DCQD versus conservative therapy (2 RCTs, 240 patients, SMD=-3.65; 95% CI -8.17 to 0.87). (2) DCQD plus conservative therapy versus conservative therapy (11 RCTs, 1,040 patients, SMD=-2.09 which favoured DCQD plus conservative therapy; 95% CI -3.04 to -1.15). DCQD combined with conservative therapy may increase the success rate of conservative therapy for intestinal obstruction significantly and can shorten the duration of postoperative ileus in patients undergoing abdominal surgery compared with conservative therapy alone.

Highlights

Intestinal obstruction refers to any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anal canal
Articles were independently assessed by two reviewers (YB and XFY) using predesigned eligibility criteria: 1) randomised controlled trials; 2) diagnosis of intestinal obstruction based on case history, clinical manifestations and diagnostic imaging (X-ray or computed tomography scan); 3) interventions: Da-Cheng-Qi decoction (DCQD) or DCQD plus conservative therapy compared with conservative therapy (DCQD jiajian was allowed); 4) decoction administered via oral and/or rectal; 5) therapeutic effect was estimated by the improvement of clinical manifestations and/or diagnostic imaging (X-ray or computed tomography scan); 6) dichotomous/ordinal data assessment of overall response to therapy, adverse effects; or continuous variable were identified, including time to first flatus, time to first bowel movement, length of hospital stay
There were 24 (13.2%) of 182 patients assigned to DCQD who failed to respond to therapy, compared with 38 (21.2%) of 179 allocated to conservative therapy (RR of respond=1.13; 95% confident intervals (CIs) 0.97 to 1.31) (Fig 2)

Summary

Introduction

Intestinal obstruction refers to any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anal canal. It can be classified according to pathogenesis: ileus (a transient impairment of bowel motility caused by operation, inflammation, metabolism, neurogenic reasons and drugs) and mechanical intestinal obstruction It accounts for approximately 15% of all emergency department visits for acute abdominal pain (Williams et al, 2005)). Conclusion: DCQD combined with conservative therapy may increase the success rate of conservative therapy for intestinal obstruction significantly and can shorten the duration of postoperative ileus in patients undergoing abdominal surgery compared with conservative therapy alone

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