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Berberine for diarrhea in children and adults: a systematic review and meta-analysis

BACKGROUND: Diarrhea is a ubiquitous digestive system disease, leading to loss of fluid and electrolytes, and may be life-threatening, especially in children and adults who are immunosuppressed or malnourished. Berberine has a broad-spectrum antibiotic activity and is very widely used to treat diarr...

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Autores principales: Yu, Mingkun, Jin, Xuejing, Liang, Changhao, Bu, Fanlong, Pan, Deng, He, Qian, Ming, Yang, Little, Paul, Du, Hongbo, Liang, Shibing, Hu, Ruixue, Li, Chengze, Hu, Yanhong Jessika, Cao, Huijuan, Liu, Jianping, Fei, Yutong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586028/
https://www.ncbi.nlm.nih.gov/pubmed/33149763
http://dx.doi.org/10.1177/1756284820961299
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author Yu, Mingkun
Jin, Xuejing
Liang, Changhao
Bu, Fanlong
Pan, Deng
He, Qian
Ming, Yang
Little, Paul
Du, Hongbo
Liang, Shibing
Hu, Ruixue
Li, Chengze
Hu, Yanhong Jessika
Cao, Huijuan
Liu, Jianping
Fei, Yutong
author_facet Yu, Mingkun
Jin, Xuejing
Liang, Changhao
Bu, Fanlong
Pan, Deng
He, Qian
Ming, Yang
Little, Paul
Du, Hongbo
Liang, Shibing
Hu, Ruixue
Li, Chengze
Hu, Yanhong Jessika
Cao, Huijuan
Liu, Jianping
Fei, Yutong
author_sort Yu, Mingkun
collection PubMed
description BACKGROUND: Diarrhea is a ubiquitous digestive system disease, leading to loss of fluid and electrolytes, and may be life-threatening, especially in children and adults who are immunosuppressed or malnourished. Berberine has a broad-spectrum antibiotic activity and is very widely used to treat diarrhea in China. No systematic review has been carried out to evaluate the evidence presented in clinical trials. The aim of this study was to assess the effectiveness and safety of berberine in diarrhea treatment among children and adults. METHODS: Seven databases and two clinical trial registries were searched on 1 September 2019. Randomized controlled trials were included, where participants were diagnosed (first diagnosed) as having diarrhea according to clear diagnostic criteria. Berberine alone or in combination with Western medication as intervention were included. Subgroup analyses were conducted based on children or adults, acute or persistent diarrhea, infectious or noninfectious and treatment courses. Primary outcomes were clinical cure rate and duration of diarrhea. The GRADE tool was used to assess the quality of evidence. RESULTS: A total of 38 randomized controlled trials were included involving 3948 participants (including 27 trials on 2702 children) were included. Compared with antibiotics, berberine plus antibiotics showed better results in both adults and in children in general, especially when given for 7 days or 3 days in acute infectious diarrhea of children. Compared with the control groups, using berberine alone or in combination with montmorillonite, probiotics, and vitamin B increased the clinical cure rate of diarrhea. The use of berberine alone or berberine combined with montmorillonite reduced the duration of hospitalization. Using berberine had significantly better laboratory indicators (isoenzyme, inflammatory factors, myocardial enzyme, and fecal trait) and fewer systemic symptoms than the no berberine groups. Overall, 22 of 27 trials on children used berberine as an enema. No deaths and serious adverse events were reported. The quality of evidence of included trials was moderate to low or very low. The impact of different dosages, frequencies and treatment durations on the outcomes was not evaluated due to insufficient number of trials. CONCLUSION: This review demonstrated that berberine was generally effective in improving clinical cure rates and shortening the duration of diarrhea compared with control groups. No severe adverse event was reported. However, there is still a lack of high-quality evidence for evaluating the efficacy and safety of berberine. TRIAL REGISTRATION: PROSPERO CRD42020151001 (available from http://www.crd.york.ac.uk/PROSPERO/).
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spelling pubmed-75860282020-11-03 Berberine for diarrhea in children and adults: a systematic review and meta-analysis Yu, Mingkun Jin, Xuejing Liang, Changhao Bu, Fanlong Pan, Deng He, Qian Ming, Yang Little, Paul Du, Hongbo Liang, Shibing Hu, Ruixue Li, Chengze Hu, Yanhong Jessika Cao, Huijuan Liu, Jianping Fei, Yutong Therap Adv Gastroenterol Meta-Analysis BACKGROUND: Diarrhea is a ubiquitous digestive system disease, leading to loss of fluid and electrolytes, and may be life-threatening, especially in children and adults who are immunosuppressed or malnourished. Berberine has a broad-spectrum antibiotic activity and is very widely used to treat diarrhea in China. No systematic review has been carried out to evaluate the evidence presented in clinical trials. The aim of this study was to assess the effectiveness and safety of berberine in diarrhea treatment among children and adults. METHODS: Seven databases and two clinical trial registries were searched on 1 September 2019. Randomized controlled trials were included, where participants were diagnosed (first diagnosed) as having diarrhea according to clear diagnostic criteria. Berberine alone or in combination with Western medication as intervention were included. Subgroup analyses were conducted based on children or adults, acute or persistent diarrhea, infectious or noninfectious and treatment courses. Primary outcomes were clinical cure rate and duration of diarrhea. The GRADE tool was used to assess the quality of evidence. RESULTS: A total of 38 randomized controlled trials were included involving 3948 participants (including 27 trials on 2702 children) were included. Compared with antibiotics, berberine plus antibiotics showed better results in both adults and in children in general, especially when given for 7 days or 3 days in acute infectious diarrhea of children. Compared with the control groups, using berberine alone or in combination with montmorillonite, probiotics, and vitamin B increased the clinical cure rate of diarrhea. The use of berberine alone or berberine combined with montmorillonite reduced the duration of hospitalization. Using berberine had significantly better laboratory indicators (isoenzyme, inflammatory factors, myocardial enzyme, and fecal trait) and fewer systemic symptoms than the no berberine groups. Overall, 22 of 27 trials on children used berberine as an enema. No deaths and serious adverse events were reported. The quality of evidence of included trials was moderate to low or very low. The impact of different dosages, frequencies and treatment durations on the outcomes was not evaluated due to insufficient number of trials. CONCLUSION: This review demonstrated that berberine was generally effective in improving clinical cure rates and shortening the duration of diarrhea compared with control groups. No severe adverse event was reported. However, there is still a lack of high-quality evidence for evaluating the efficacy and safety of berberine. TRIAL REGISTRATION: PROSPERO CRD42020151001 (available from http://www.crd.york.ac.uk/PROSPERO/). SAGE Publications 2020-10-23 /pmc/articles/PMC7586028/ /pubmed/33149763 http://dx.doi.org/10.1177/1756284820961299 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Meta-Analysis
Yu, Mingkun
Jin, Xuejing
Liang, Changhao
Bu, Fanlong
Pan, Deng
He, Qian
Ming, Yang
Little, Paul
Du, Hongbo
Liang, Shibing
Hu, Ruixue
Li, Chengze
Hu, Yanhong Jessika
Cao, Huijuan
Liu, Jianping
Fei, Yutong
Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title_full Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title_fullStr Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title_full_unstemmed Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title_short Berberine for diarrhea in children and adults: a systematic review and meta-analysis
title_sort berberine for diarrhea in children and adults: a systematic review and meta-analysis
topic Meta-Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586028/
https://www.ncbi.nlm.nih.gov/pubmed/33149763
http://dx.doi.org/10.1177/1756284820961299
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