Eli D. Ehrenpreis, MD, FACG1, Meghana Doniparthi, MD1, Mary DeMent, DO1, Cindy Pulido, MD2, Mery B. Bartl, MD3; 1Advocate Lutheran General Hospital, Park Ridge, IL; 2Advocate Lutheran General Hospital, Chicago, IL; 3Advocate Lutheran General Hospital, Crestwood, IL
Introduction: Anticholinergic drugs are commonly used for GI disease. For example, about 1 million prescriptions are written annually for hyoscyamine. However, their use does not appear to be confirmed by high quality evidenced-based medicine.
To explore evidence for the efficacy and safety of anticholinergic drugs used for
gastrointestinal (GI) disorders. We also focused on risk for cognitive side effects, dementia and falls. Methods: A literature search using Cochrane library, CINAHL, Google Scholar, Ovid and MEDLINE was conducted of all English language published literature to the present. Randomized controlled trials (RCTs), observational, cross-sectional studies, and case series dating from 1975 to 2020 were eligible for review. Quality criteria included participant range was 20 to 2000 individuals, age range from 12 to 90 years old, duration range of 1 to 13 months. Quality-based diagnoses included Infantile Colic, Functional Abdominal Pain, and IBS meeting Manning, Rome I, II, III or IV criteria. Studies needed to include the use of any of the following anticholinergic drugs: Dicyclomine, Hyoscine, Hyoscyamine and Atropine. Outcomes of interest were efficacy of anticholinergic drugs and side effects. Critical appraisals of the included studies were performed by three independent reviewers. Data were extracted onto standardized forms. The study was registered with PROSPERO Results: Nine articles met initial criteria for review (Figure 1). Of these, 8 were issued before 1991. Selected studies had a duration of 1 to 13 months. None of the articles used appropriate diagnostic criteria listed above, (Table 1). Most reported a variety of adverse reactions, including cognitive side effects. The most common reported adverse reactions were dry mouth, dizziness and blurry vision. A summary of the articles is included in Table 2. Discussion: Despite widespread use of anticholinergic drugs for GI disorders, there is no high-quality data on efficacy, and limited information on their potential side effects. The benefit of anticholinergics for GI disorders using standard diagnostic criteria appears to be unproven. Potential adverse effects require further documentation. At present, anticholinergic drugs are not recommended for the management of GI conditions.
Table 1. Data Quality Assessment
Table 2. Summary of Results and Side Effects of Studies Included.
Figure 1. Flow Diagram
Disclosures: Eli Ehrenpreis: E2Bio Consultants – Stockholder/Ownership Interest (excluding diversified mutual funds), Chief Executive Officer. E2Bio Life Sciences – Patent Holder, Stockholder/Ownership Interest (excluding diversified mutual funds), Chief Executive Officer. Level Ex, Inc. – Consultant. Meghana Doniparthi indicated no relevant financial relationships. Mary DeMent indicated no relevant financial relationships. Cindy Pulido indicated no relevant financial relationships. Mery Bartl indicated no relevant financial relationships.