Add-on effect of crude rhubarb to somatostatin for acute pancreatitis: A meta-analysis of randomized controlled trials

Ethnopharmacological relevance: Rhubarb is one of the common herbs used in traditional Chinese complex prescriptions for the treatment of various inflammatory diseases. We sought to determine the add-on effect of crude rhubarb to somatostatin in patients with acute pancreatitis by conducting a meta-analysis.

Materials and methods: We searched the Pubmed, EMBASE, Cochrane Library, CNKI, Wanfang, VIP databases up to November 2015. Randomized controlled trials (RCTs) comparing crude rhubarb plus somatostatin to somatostatin alone for acute pancreatitis were included. Risk ratio (RR) or weighted mean difference (WMD) with their 95% confidence interval (CI) was calculated between with and without crude rhubarb therapy.

Results: A total of 19 RCTs involving 1161 patients were identified. Compared with somatostatin alone, crude rhubarb plus somatostatin significantly reduced the total complications (RR 0.55; 95% CI 0.41-0.73) and APACHE Ⅱ scores (WMD -1.16; 95% CI -1.91 to -0.41) as well as shortened the duration of elevated serum amylase (WMD -2.01 days; 95% CI -2.57 to -1.44), duration of abdominal pain (WMD -1.33 days; 95% CI -1.61 to -1.05), the first defecation time (WMD -2.27 days; 95% CI -3.06 to -1.47), and duration of hospital stay (WMD -6.70 days; 95% CI -8.81 to -4.60). However, there were no significant differences in total mortality rates (RR 0.61; 95% CI 0.34 to 1.12) between two groups.

Conclusions: Crude rhubarb as adjuvant therapy to somatostatin appears to have additional benefits in patients with acute pancreatitis. However, interpretation of these results should be cautioned due to the methodological flaws.