Advice

Appendix: Search strategy and evidence selection

Appendix: Search strategy and evidence selection

Search strategy

General background, guidelines and technology assessments:

MEDLINE (via Ovid)

Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1946 to Present>

Search Strategy:

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  1. Gastroparesis/ (1009)

  2. exp Gastrointestinal Motility/ (31668)

  3. gastroparesis.tw. (1438)

  4. ((gut or gastr$ or intestin$) adj3 (motil$ or stimulat$ or emptying or volume)).tw. (25995)

  5. (prokinetic? or motilin).tw. (3274)

  6. or/1-5 (47859)

  7. exp Erythromycin/ (20430)

  8. (erythromycin or erythrocin).tw. (16475)

  9. or/7-8 (28591)

  10. 6 and 9 (770)

  11. exp review/ (1762473)

  12. (scisearch or psychinfo or psycinfo or medlars or embase or psychlit or psyclit or cinahl or pubmed or medline).ti,ab,sh. (72606)

  13. ((hand adj2 search$) or (manual$ adj2 search$)).ti,ab,sh. (6307)

  14. ((electronic or bibliographic or computeri?ed or online) adj4 database$).ti,ab. (14079)

  15. (pooling or pooled or mantel haenszel).ti,ab,sh. (46568)

  16. (peto or dersimonian or der simonian or fixed effect).ti,ab,sh. (2711)

  17. or/12-16 (124050)

  18. 11 and 17 (55034)

  19. Meta Analysis/ (38447)

  20. (meta-analys$ or meta analys$ or metaanalys$).ti,ab,sh. (67979)

  21. ((systematic$ or quantitativ$ or methodologic$) adj5 (review$ or overview$ or synthesis$)).ti,ab,sh. (54721)

  22. (integrative research review$ or research integration).ti,ab,sh. (83)

  23. or/19-22 (105814)

  24. 18 or 23 (133970)

  25. clinical trials, phase iv/ or clinical trials, phase iii/ or randomized controlled trials/ or multicenter studies/ (239776)

  26. (random$ or placebo$ or ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$))).ti,ab,sh. (881775)

  27. 25 or 26 (978772)

  28. (animal$ not human$).sh. (3697331)

  29. 27 not 28 (873244)

  30. (cost$ or economic$).tw. (428385)

  31. 24 or 29 or 30 (1338733)

  32. 10 and 31 (200)

  33. (child$ or neonat$ or infant$).ti. (737652)

  34. 32 not 33 (167)

Embase (via Ovid)

Database: Embase <1988 to 2013 March 27>

Search Strategy:

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  1. Gastroparesis/ (3010)

  2. exp Gastrointestinal Motility/ (17703)

  3. gastroparesis.tw. (2156)

  4. ((gut or gastr$ or intestin$) adj3 (motil$ or stimulat$ or emptying or volume)).tw. (24434)

  5. Prokinetic Agent/ (2713)

  6. (prokinetic? or motilin).tw. (3717)

  7. or/1-6 (39489)

  8. exp Erythromycin/ (44780)

  9. Erythromycin Stearate/ (245)

  10. (erythromycin or erythrocin).tw. (15802)

  11. or/8-10 (48214)

  12. 7 and 11 (1759)

  13. exp review/ (1749103)

  14. (scisearch or psychinfo or psycinfo or medlars or embase or psychlit or psyclit or cinahl or pubmed or medline).ti,ab,sh. (90738)

  15. ((hand adj2 search$) or (manual$ adj2 search$)).ti,ab,sh. (7500)

  16. ((electronic or bibliographic or computeri?ed or online) adj4 database$).ti,ab. (18342)

  17. (pooling or pooled or mantel haenszel).ti,ab,sh. (53580)

  18. (peto or dersimonian or der simonian or fixed effect).ti,ab,sh. (3441)

  19. or/14-18 (150582)

  20. 13 and 19 (58085)

  21. Meta Analysis/ (69811)

  22. (meta-analys$ or meta analys$ or metaanalys$).ti,ab,sh. (100151)

  23. ((systematic$ or quantitativ$ or methodologic$) adj5 (review$ or overview$ or synthesis$)).ti,ab,sh. (94215)

  24. (integrative research review$ or research integration).ti,ab,sh. (88)

  25. or/21-24 (165556)

  26. 20 or 25 (193552)

  27. clinical trials, phase iv/ or clinical trials, phase iii/ or randomized controlled trials/ or multicenter studies/ (32839)

  28. (random$ or placebo$ or ((singl$ or double$ or triple$ or treble$) and (blind$ or mask$))).ti,ab,sh. (1005043)

  29. 27 or 28 (1008655)

  30. (animal$ not human$).sh. (2488267)

  31. 29 not 30 (910462)

  32. (cost$ or economic$).tw. (483579)

  33. 26 or 31 or 32 (1459226)

  34. 12 and 33 (442)

  35. (child$ or neonat$ or infant$).ti. (580915)

  36. 34 not 35 (390)

  37. limit 36 to exclude medline journals (43)

  38. limit 37 to english language (34)

Cochrane Central Register of Controlled Trials (CENTRAL)

Date Run: 28/03/13 15:00:53.727

ID Search Hits

#1 MeSH descriptor: [Gastroparesis] explode all trees 96

#2 MeSH descriptor: [Gastrointestinal Motility] explode all trees 2336

#3 gastroparesis or (gastr* next/2 motility) or (gastr* next/2 emptying):ti,ab,kw (Word variations have been searched) 2920

#4 prokinetic* or "motilin":ti,ab,kw (Word variations have been searched) 535

#5 #1 or #2 or #3 or #4 3591

#6 MeSH descriptor: [Erythromycin] this term only 882

#7 "erythromycin" or "erythrocin":ti,ab,kw (Word variations have been searched) 1555

#8 #6 or #7 1555

#9 #5 and #8 in Trials 170

CRD HTA, DARE and EED database

(gastroparesis) OR (gastr* emptying) OR (gastr* motility) OR (prokinetic) OR (motilin) AND (erythromycin)

Grey literature and ongoing trials

Manufacturers' websites

There are a large number of generic and branded erythromycin formulations available. See the relevant summaries of product characteristics for links to the various manufacturers.

Evidence selection

This evidence summary has included studies that have investigated the efficacy of oral erythromycin for treating gastroparesis of any underlying cause in adults.

Studies have been excluded if their aim was to investigate the effect of erythromycin on gastric emptying and gastrointestinal transit times rather than treating symptoms of gastroparesis. This has included studies comparing pre- or post-operative doses of erythromycin as prophylaxis in people undergoing abdominal surgery to investigate whether this has an effect on outcomes such as gastric volume or emptying or gastrointestinal symptoms. Studies focusing on whether erythromycin improves transit times and image quality in people undergoing capsule endoscopy, and trials of non-antibiotic derivatives of erythromycin (ABT-229), have also been excluded.

One relevant systematic review (Maganti et al. 2003) was identified, which contained most of the evidence in this summary. This review identified only crossover studies and uncontrolled trials, all of which enrolled fewer than 20 participants. Trials with fewer than 20 participants, or cohort studies and case series, would not usually meet the inclusion criteria. However, these trials were reviewed on the basis that they had been identified through a systematic review, which was a study design that met the criteria for inclusion in this evidence summary.

The search results were reviewed to identify whether any relevant randomised controlled trials of oral erythromycin for treating gastroparesis (of any underlying cause) in adults had been published after the systematic review, but no further trials were identified. Following on from this, in view of the limited evidence identified, a further search was performed to identify any relevant observational data published since the systematic review. A single study, a retrospective chart review (Dhir and Richter 2004) was identified.