Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: A meta-analysis

BACKGROUND: The efficacy of prokinetic agents in functional (nonulcer) dysp epsia has been questioned based on recent trial results. We performed a met a-analysis to determine the efficacy of cisapride and domperidone in functi onal dyspepsia. METHODS: Computer and manual searching was used to identify placebo-control led studies that included >20 patients. The statistical analysis focused on : global assessment by the investigator, epigastric pain, early satiety, ab dominal distension and nausea tall rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis wa s performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated. RESULTS: For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For a ll outcome measures, there was a statiscally significant benefit ill favor of cisapride: global assessment of improvement by the investigator or patie nt (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), ea rly satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% C I 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of p ublication, and country where study was performed bad only small modifying effects. There were insufficient data to determine whether there is a relat ionship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of gl obal assessment of improvement by the investigator. This showed an OR of 7. 0 (95% CI 3.6-16) in favor of domperidone. CONCLUSIONS: Both cisapride and domperidone seem to be efficacious in funct ional dyspepsia, although this conclusion is largely based on global assess ment by the investigator, which may not be an optimal outcome measure. (C) 2001 by Am. Cell. of Gastroenterology.