Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic

Summary Background Biliary colic is a common manifestation of cholelithiasis, developing in about one‐third of patients. Even if nonsteroid anti‐inflammatory drugs (NSAIDs) have widely been used to relieve biliary pain, there is a lack of systematic review of treatments on this issue. Aim To assess the potential benefits in terms of both pain control and reduction of complications, and the potential harms of NSAIDs in patients with biliary colic. Methods Data from randomised clinical trials (RCTs) comparing NSAIDs with no treatment, placebo or other drugs in patients with biliary colic, were collected from Medline and Embase. The outcome measures were expressed as odds ratio and relative risk and then pooled using fixed or random‐effect models. Results Eleven RCTs involving 1076 subjects (268 men, 808 women; 18–86 years), including 442 controls were analysed. In comparison with placebo, NSAIDs led to a significantly higher proportion of patients with complete pain relief (RR 3.77, 95%CI 1.65–8.61; I 2: 73%) and a significantly lower rate of complications (RR 0.53, 95% CI 0.31–0.89; I 2: 35%). In comparison with other drugs, NSAIDs were more efficacious in controlling pain than spasmolytics (RR 1.47, 95% CI 1.03–2.10; I 2: 55%); there was no difference between NSAIDs and opioids (RR 1.05, 95% CI 0.82–1.33; I 2: 74%). Conclusions In patients with biliary colic NSAIDs are the first‐choice treatments as they control pain with the same efficacy of opioids and significantly reduce the proportion of patients with severe complications. However, the lack of high‐quality RCTs and the presence of consistent heterogeneity among studies may partially flaw these results.