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Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis

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Abstract

Background

The role of adjunctive steroids in abdominal tuberculosis is unclear.

Objective

To evaluate effect of adjunctive use of steroids for abdominal tuberculosis in reducing/preventing complications.

Methods

We searched electronic databases (Medline, Embase, CENTRAL, Scopus, Web of Science, CINAHL) from inception to 25th June 2018 using the terms “abdominal tuberculosis” OR “intestinal tuberculosis” OR “peritoneal tuberculosis” OR “tuberculous peritonitis” AND steroids OR methylprednisolone OR prednisolone. Bibliography of potential articles was also searched. We included studies comparing adjunctive steroids to antitubercular therapy (ATT) alone. We excluded non-English articles, case reports, reviews and unrelated papers. The primary outcome was a comprehensive clinical outcome including need for surgery or the presence of symptomatic stricture (abdominal pain or intestinal obstruction). Quality assessment of included studies was done using ROBINS-I tool. Random-effects model was used to calculate the summary effect for all the outcomes.

Results

Of total 633 records, three studies on peritoneal tuberculosis were included in meta-analysis. These papers were of poor quality (one quasi-randomised study and two retrospective cohort studies). Meta-analyses showed adjunctive steroids, with ATT is more effective than ATT alone in tuberculous peritonitis patients for the prevention of composite end point (RR 0.15 [0.04, 0.62], p = 0.008), symptomatic stricture(RR 0.15 [0.04–0.62] p = 0.008) and intestinal obstruction (RR 0.18 [0.03–0.99] p = 0.05).

Conclusion

The data on use of steroids for abdominal tuberculosis are limited to peritoneal tuberculosis. Although steroids seem to have some benefit in patients of tubercular peritonitis, the poor quality of studies limits the generalisability of the findings.

Systematic review registration number

CRD42016047347.

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Authors and Affiliations

  1. Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Hariom Soni & Praveen M. Kumar

  2. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Balaji L. Bellam, Harshal S. Mandavdhare, Usha Dutta & Vishal Sharma

  3. Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Raghavendra K. Rao

  4. Department of General Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Harjeet Singh

Authors
  1. Hariom Soni
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  2. Balaji L. Bellam
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  3. Raghavendra K. Rao
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  4. Praveen M. Kumar
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  5. Harshal S. Mandavdhare
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  6. Harjeet Singh
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  7. Usha Dutta
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  8. Vishal Sharma
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Contributions

VS, HaS (Harjeet Singh): Conception. HS (Hariom Soni), BLB, VS: Literature search. HS, BLB, RRK, PMK, VS: Data extraction and risk of bias assessment. HS, BLB, RRK, PMK, VS: Data analysis. HS, BLB, VS: Initial draft. HSM, HaS, UD, VS: Important intellectual content and manuscript revision. HS, BLB: Equal contribution. All authors: final approval.

Corresponding author

Correspondence to Vishal Sharma.

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Soni, H., Bellam, B.L., Rao, R.K. et al. Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 47, 387–394 (2019). https://doi.org/10.1007/s15010-018-1235-0

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  • DOI: https://doi.org/10.1007/s15010-018-1235-0

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