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Evidence summaries

Non-Steroidal Anti-Inflammatory Drugs for Biliary Colic

Non-steroidal anti-inflammatory drugs are effective for biliary colic compared with placebo and may be more effective than spasmolytic drugs. Level of evidence: "A"

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment in most of the trials) and upgraded by large magnitude of effect.

Summary

A Cochrane review [Abstract] 1 included 12 studies with a total of 828 subjects. When compared with placebo, NSAIDs obtained a significantly lower proportion of participants without complete pain relief (table T1), which was confirmed by Trial Sequential Analysis. NSAIDs showed more pain control than spasmolytic drugs (table T1), which was not confirmed by Trial Sequential Analysis. No difference was found in the proportions of participants without complete pain relief when comparing NSAIDs versus opioids (table T1). None of the included trials reported severe adverse events. Seven trials assessed non-severe adverse events: in 2, adverse events were not observed, and minor events were reported in the remaining 5 trials. There was no mortality.

Non-steroidal anti-inflammatory drugs versus placebo/opioids/spasmolytic drugs for biliary colic

OutcomeRelative effect(95% CI)Risk with controlRisk with intervention - NSAIDs (95% CI)No of Participants(studies) Quality of evidence
Lack of pain reliefRR 0.27 (0.19 to 0.4)Placebo 784 / 1000212 / 1000(149 to 314)208(5) Moderate
Cholelithiasis-related complicationsRR 0.66 (0.38 to 1.15)471 / 1000311 / 1000(179 to 541)140(3) Very low
Lack of pain reliefRR 0.98 (0.47 to 2.07)Opioids 180 / 1000176 / 1000(84 to 372)459(4) Very low
Cholelithiasis-related complicationsRR 0.88 (0.14 to 5.42)143 / 1000126 / 1000(20 to 774)30(1) Very low
Lack of pain reliefRR 0.51 (0.37 to 0.71)Spasmolytics 598 / 1000305 / 1000(221 to 424)190(4) Low
Cholelithiasis-related complicationsRR 0.27 (0.12 to 0.57)462 / 1000125 / 1000(55 to 263)104(2) Low

Clinical comments

Note

Date of latest search: 15 July 2016

References

  • Fraquelli M, Casazza G, Conte D et al. Non-steroid anti-inflammatory drugs for biliary colic. Cochrane Database Syst Rev 2016;(9):CD006390. [PubMed]

Primary/Secondary Keywords