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      Papel de la domperidona en el tratamiento de la dispepsia no ulcerosa: una revisión sistemática Translated title: Rol of domperidone in the treatment of non-ulcer dyspepsia: A systematic review

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          Abstract

          El manejo de los pacientes con dispepsia no ulcerosa sigue siendo un enigma. A pesar de los múltiples tratamientos con que actualmente contamos para el manejo de esta enfermedad, ninguno ha mostrado un beneficio muy superior a lo logrado por los placebos. Una de las terapias más comúnmente empleadas para tratar esta enfermedad es la de los proquinéticos. Entre este tipo de tratamiento, la domperidona, que es una antagonista de los receptores dopaminérgicos ha mostrado un efecto terapéutico regular. El propósito de esta revisión sistemática es evaluar la bibliografía existente sobre el papel del la domperidona en el tratamiento de los pacientes con dispepsia no ulcerosa. Después de un análisis crítico de la literatura podemos concluir que la domperidona es una medicación segura y útil en el tratamiento de la dispepsia no ulcerosa; de hecho el número necesario de tratar es de 4.

          Translated abstract

          The treatment of non-ulcer dyspepsia keeps on being a conundrum. In spite of the many treatments that we have to deal with this disease neither has shown a benefit much higher than the placebo. One of the most common types of medication to treat this disease is the proquinetics. Among this class of medications; domperidone which is a dopaminergic antagonist has shown a moderate effect. The porpoise of this systematic review is assessing the existent bibliography over the actual roll of domperidone in the treatment of patients with non-ulcer dyspepsia. After the critical appraisal of the literature that I have done; we can conclude that domperidona is safe and useful in the treatment of non-ulcer dyspepsia, in fact the number needed to treat is only 4.

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          Most cited references16

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          Pharmacological interventions for non-ulcer dyspepsia.

          The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this condition has been poorly characterised and the optimum treatment is uncertain. It is estimated that pound450 million is spent on dyspepsia drugs in the UK each year. This review aims to determine the effectiveness of six classes of drugs (antacids, histamine H(2) antagonists, proton pump inhibitors, prokinetics, mucosal protecting agents and antimuscarinics) in the improvement of either the individual or global dyspepsia symptom scores and also quality of life scores patients with non-ulcer dyspepsia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005), MEDLINE (1966 to January 2006), EMBASE (1988 to January 2006), CINAHL (1982 to January 2006), SIGLE, and reference lists of articles. We also contacted experts in the field and pharmaceutical companies. Trials were located through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and text words, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and pharmaceutical companies. All randomised controlled trials (RCTs) comparing drugs of any of the six groups with each other or with placebo for non-ulcer dyspepsia (NUD). Two review authors independently assessed eligibility, trial quality and extracted data. We included 73 trials: prokinetics (19 trials with dichotomous outcomes evaluating 3178 participants; relative risk reduction (RRR) 33%; 95% confidence intervals (CI) 18% to 45%), H(2)RAs (12 trials evaluating 2,183 participants; RRR 23%; 95% CI 8% to 35%) and PPIs (10 trials evaluating 3,347 participants; RRR 13%; 95% CI 4% to 20%) were significantly more effective than placebo. Bismuth salts (six trials evaluating 311 participants; RRR 40%; 95% CI -3 to 65%) were superior to placebo but this was of marginal statistical significance. Antacids (one trial evaluating 109 participants; RRR -2%; 95% CI -36% to 24%) and sucralfate (two trials evaluating 246 participants; RRR 29%; 95% CI -40% to 64%) were not statistically significantly superior to placebo. A funnel plot suggested that the prokinetic results could be due to publication bias or other small study effects. There is evidence that anti-secretory therapy may be effective in NUD. The trials evaluating prokinetic therapy are difficult to interpret as the meta-analysis result could have been due to publication bias. The effect of these drugs is likely to be small and many patients will need to take them on a long-term basis so economic analyses would be helpful and ideally the therapies assessed need to be inexpensive and well tolerated.
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            Effects of domperidone in patients with chronic unexplained upper gastrointestinal symptoms: A double-blind, placebo-controlled study

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              Levosulpiride in functional dyspepsia: a multicentric, double-blind, controlled trial.

              Abnormalities in gastrointestinal motility have been reported in a substantial proportion of patients with functional dyspepsia, supporting the use of prokinetic drugs for treatment of dyspeptic symptoms. To evaluate efficacy and safety of levosulpiride in short-term treatment, 1298 patients were enrolled in a double-blind multicentric study carried out in 45 Italian Gastroenterology Departments. Patients were randomly assigned to either levosulpiride (25 mg tid), domperidone (10 mg tid), metoclopramide (10 mg tid) or placebo (1 tablet tid) for 4 weeks. Patients were selected on the basis of: a) occurrence in the last 4 weeks of at least 5/10 selected symptoms (anorexia, nausea, vomiting, upper abdominal pain, postprandial bloating, abdominal fullness, early satiety, belching, heartburn, regurgitation), severity of which should reach/exceed a total score of 8, as assessed by a specific scale ranging from 0 (absent) to 3 (severe); b) normal results of routine biochemical, ultrasound and endoscopic examinations. In addition, each patient subjectively evaluated efficacy of treatment by a visual analogue scale. Significant improvement was recorded for all symptoms at days 10 and 28 in all groups (p < 0.001), but levosulpiride was significantly (p < 0.01) superior to domperidone, metoclopramide and placebo both in the overall clinical improvement scale as well as in a subgroup of symptoms (postprandial bloating, epigastric pain, heartburn). Active treatments and placebo were comparable as far as concerns occurrence of side-effects (12-20%) including galactorrhoea, breast tenderness and menstrual changes.
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                Author and article information

                Contributors
                Role: ND
                Journal
                rcg
                Revista Colombiana de Gastroenterologia
                Rev Col Gastroenterol
                Asociación Colombiana de Gastroenterología (Bogotá )
                0120-9957
                December 2006
                : 21
                : 4
                : 261-266
                Affiliations
                [1 ] Fundación Santa Fe de Bogotá Colombia
                Article
                S0120-99572006000400005
                b4eec30b-70fe-4b71-b363-56c725d59c08

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0120-9957&lng=en
                Categories
                GASTROENTEROLOGY & HEPATOLOGY

                Gastroenterology & Hepatology
                Non ulcer dyspepsia,proquinetics,Domperidona,number needed to treat,Dispepsia no ulcerosa,procinéticos,omperidona,número necesario de tratar

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