A systematic review and meta-analysis published in the Cochrane Database of Systematic Reviews found that for patients with ulcerative colitis (UC), there is a paucity of robust evidence on the safety and efficacy of potential interventions for the management of abdominal pain.

Publication databases were searched through April of 2021 for studies on the management of abdominal pain among patients with UC. Potential interventions could include pharmacological interventions, behavioral therapy, lifestyle advice, dietary interventions, prebiotics, probiotics, or alternative therapies. A total of 5 studies consisting of 360 patients were included in this analysis.

The study participants ranged in age between a mean of 30.4 and 47.6 years. Three studies included both patients with UC and Crohn disease (CD) and the other 2 recruited only patients with UC. Among the studies, 2 analyzed patients with inactive disease, 1 analyzed those with inactive to moderate disease, and 2 included patients with unspecified disease state.


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All 5 studies used differing interventions lasting between 30 days to 8 weeks, including: stellate ganglion block vs sulphasalazine, low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet vs sham diet, kefir diet vs no intervention, relaxation training vs waiting list, or yoga vs no intervention.

The ganglion block study administered the block to 90 patients and sulphasalazine to 30 patients. Pain frequency and treatment success were not reported and data about pain intensity were unclear.

For the studies on dietary interventions, the low FODMAP and sham diets were assigned to 13 patients each. Neither pain frequency (mean difference [MD], -4.00; 95% CI, -20.61 to 12.61) nor intensity (MD, -9.00; 95% CI, -20.07 to 2.07) were significantly improved and no data about treatment success were reported. The other diet intervention assigned 15 patients each to receive kefir or no intervention. Pain intensity was not significantly decreased (MD, -0.17; 95% CI, -0.91 to 0.57) and neither pain frequency nor treatment success were reported.

The study of alternative relaxation therapy assigned 20 patients to relaxation training and 20 to wait-list. Uncertain results were reported for pain frequency (MD, 3.30; 95% CI, 1.64-4.96) or intensity (MD, -2.30; 95% CI, -3.70 to -0.90) at 6 months. For yoga, 30 patients received yoga and 30 were assigned to the control group. However, the reported outcomes were unclear.

This analysis was limited by the lack of robust studies on abdominal pain management among patients with UC, leading the authors to conclude that additional studies about pain management among this population are urgently needed.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Sinopoulou V, Gordon M, Dovey TM, Akobeng AK. Interventions for the management of abdominal pain in ulcerative colitis. Cochrane Database Syst Rev. 2021;7(7):CD013589. doi:10.1002/14651858.CD013589.pub2