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REVIEW ARTICLE
Anti-Helicobacter pylori treatment can effectively improve the clinical remission rates of irritable bowel syndrome: a controlled clinical trial meta-analysis
Yan XiongI, Lulu LiuI, Xuchun ZhouI,
Corresponding author
chqxchzh@163.com

Corresponding author.
, Youfei WenI, Ruonan WangII
I Department of Gastroenterology, the First Affiliated Hospital of Chongqing Medical University, People's Republic of China
II Hainan Medical College, People's Republic of China
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Irritable bowel syndrome &#40;IBS&#41; is a functional gastrointestinal disease with variable incidence rate in countries across the globe&#46; Incomplete statistics suggest that the worldwide incidence of IBS ranges from 7&#37; to 15&#37; with this increasing to as much as 20&#37; in some populations in China &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#41;&#46; IBS is characterized by recurrent abdominal pain and changes in bowel movements&#46; Its influence on the quality of life cannot be ignored but clinical interventions remain largely ineffective &#40;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#41;&#46; Studies have shown that IBS is a complex syndrome caused by long-term interactions between various psychosomatic factors&#44; neuroendocrine factors&#44; immunity&#44; drugs&#44; and infection&#44; among others &#40;<a class="elsevierStyleCrossRef" href="#bib3">3</a>&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#41;&#46; <span class="elsevierStyleItalic">Helicobacter pylori</span>&#44; an important gastroenterological pathogen has an infection rate of up to 50&#37; in Chinese populations &#40;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#41;&#44; and has been linked to a variety of digestive tract diseases&#46; However&#44; the belief that the <span class="elsevierStyleItalic">H&#46; pylori</span> infection rate in IBS patients is higher than that of the healthy population is still controversial&#46; This study was designed to evaluate meta-data from several clinical studies to identify any evidence supporting the positive relationship between anti-<span class="elsevierStyleItalic">H&#46; pylori</span> therapy and improved clinical remission rates for IBS&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">MATERIAL AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">Inclusion and exclusion criteria</span><p id="para20" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Inclusion criteria&#58;</span> The following study criteria were used&#58; &#40;1&#41; Study design&#58; clinical controlled trial&#59; &#40;2&#41; Study content&#58; discussion of any differences in the effective remission rates of IBS patients with or without anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment&#59; the specific sample size and effective remission rates for both the experimental and control groups must have been accurately recorded&#59; &#40;3&#41; Study subjects&#58; IBS patients who meet the Rome II&#44; III&#44; or IV diagnostic criteria and an <span class="elsevierStyleItalic">H&#46; pylori-positive</span> result based on either a <span class="elsevierStyleSup">13</span>C&#44; <span class="elsevierStyleSup">14</span>C urea breath test &#40;UBT&#41; or rapid urease test &#40;RUT&#41;&#59; &#40;4&#41; Study results&#58; the strategy used for the evaluation of the effective remission rate for IBS must be similar between studies&#46; Expected effect&#58; abdominal pain&#44; diarrhea&#44; constipation&#44; and other symptoms almost completely disappeared&#59; Effective outcomes&#58; abdominal pain&#44; diarrhea&#44; constipation and other symptoms are significantly reduced but still exist&#59; Invalid&#58; abdominal pain&#44; diarrhea&#44; constipation&#44; and other symptoms were not reduced or patients experienced increased severity&#46; Total effective rate &#61; &#40;number of obvious effect cases&#43;number of effective cases&#41;&#47;number of total cases &#215; 100&#37;&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">Exclusion criteria</span><p id="para30" class="elsevierStylePara elsevierViewall">The following exclusion criteria were used&#58; &#40;1&#41; Non-clinical data or repeated publications including reviews and animal studies&#59; &#40;2&#41; Unavailable text&#44; incomplete data&#44; lack of control group data or incalculable data&#59; &#40;3&#41; Articles using previously published data&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">Retrieval strategies</span><p id="para40" class="elsevierStylePara elsevierViewall">PubMed&#44; Embase&#44; the Cochrane Central Register of Controlled Trials&#44; CNKI&#44; CBM&#44; Wanfang and VIP databases were searched using various search terms&#44; including &#8220;<span class="elsevierStyleItalic">helicobacter pylori</span>&#44;&#8221; &#8220;<span class="elsevierStyleItalic">H&#46; pylori</span>&#44;&#8221; &#8220;<span class="elsevierStyleItalic">Campylobacter pylori</span>&#44;&#8221; &#8220;irritable bowel syndrome&#44;&#8221; &#8220;Irritable Bowel Syndromes&#44;&#8221; &#8220;Syndrome&#44; Irritable Bowel&#44;&#8221; &#8220;Syndromes&#44; Irritable Bowel&#44;&#8221; &#8220;Colon&#44; Irritable&#44;&#8221; &#8220;Irritable Colon&#44;&#8221; &#8220;Colitis&#44; Mucous&#44;&#8221; &#8220;Colitides&#44; Mucous&#44;&#34; &#8220;Mucous Colitides&#44;&#8221; and &#8220;Mucous Colitis&#46;&#8221; PubMed database retrieval strategy&#58; &#40;&#40;&#40;&#40;&#40;&#40;&#40;&#40;&#40;&#40;&#40;&#40;Irritable Bowel Syndromes&#91;Title&#47;Abstract&#93;&#41; OR Syndrome&#44; Irritable Bowel&#91;Title&#47;Abstract&#93;&#41; OR Syndromes&#44; Irritable Bowel&#91;Title&#47;Abstract&#93;&#41; OR Colon&#44; Irritable&#91;Title&#47;Abstract&#93;&#41; OR Irritable Colon&#91;Title&#47;Abstract&#93;&#41; OR Colitis&#44; Mucous&#91;Title&#47;Abstract&#93;&#41; OR Colitides&#44; Mucous&#91;Title&#47;Abstract&#93;&#41; OR Mucous Colitides&#91;Title&#47;Abstract&#93;&#41; OR Mucous Colitis&#91;Title&#47;Abstract&#93;&#41;&#41; OR irritable bowel syndrome&#91;Mesh&#93;&#41;&#41; AND &#40;&#40;&#40;&#40;Campylobacter pylori&#91;Title&#47;Abstract&#93;&#41; OR H&#46;pylori&#91;Title&#47;Abstract&#93;&#41;&#41; OR helicobacter pylori&#91;Mesh&#93;&#41;&#46; The search results were reviewed independently by two researchers and were evaluated by a third person if there were any objections or doubts&#46; The search period covered nearly 15 years and ended in September 2019&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">Data extraction</span><p id="para50" class="elsevierStylePara elsevierViewall">In total&#44; 170 studies from various databases were initially identified&#44; and 90 of these were then excluded as duplicates&#46; After screening the titles and abstracts of the remaining 80 studies&#44; 64 were excluded as they included non-clinical data&#44; or there was no access to the full text&#46; The full texts of the remaining studies were then screened resulting in the exclusion of an additional six studies that did not provide any data on the association between anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment and IBS clinical remission rates or because they were systematic reviews&#47;meta-analyses&#46; This left us with ten studies &#40;<a class="elsevierStyleCrossRefs" href="#bib6">6&#8211;15</a>&#41; that were eligible for meta-analysis&#44; this criteria is summarized in <a class="elsevierStyleCrossRef" href="#fig1">Fig&#46; 1</a>&#46; We extracted the first author&#39;s name&#44; year of publication&#44; IBS Rome diagnostic criteria&#44; diagnostic criteria for <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#44; the number of patients in the experimental and control groups&#44; and the effective clinical remission rate for each group&#46; These data are summarized in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><elsevierMultimedia ident="tbl1"></elsevierMultimedia></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Quality evaluation and Risk-of-bias assessments</span><p id="para60" class="elsevierStylePara elsevierViewall">The Newcastle-Ottawa Scale &#40;NOS&#41; was used to evaluate the data quality in all ten of the included studies&#44; all ten studies showed a score &#8805;6 points &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#46; At the same time&#44; two researchers &#40;YX&#44; LL&#41; independently evaluated the quality of the included studies using the Cochrane risk-of-bias criteria&#46; Every quality item was classified into unclear risk&#44; low risk&#44; or high risk&#46; Any disagreements were resolved through discussion or consultation between the two independent researchers&#44; and seven criteria were used to assess bias&#46; <a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a> summarizes the quality of the included literature and showed that all ten studies are relatively reliable&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Statistical analysis</span><p id="para70" class="elsevierStylePara elsevierViewall">RevMan 5&#46;3&#46;5 and Stata 15&#46;1 software were used to perform the meta-analysis&#46; First&#44; the I<span class="elsevierStyleSup">2</span> test was used to evaluate the heterogeneity between the studies&#46; I<span class="elsevierStyleSup">2</span>&#62;50&#37; indicated that the studies were significantly different&#44; and I<span class="elsevierStyleSup">2</span>&#60;50&#37; indicated less heterogeneity&#46; Second&#44; a random-effects model was used to pool the odds ratios &#40;ORs&#41; for each evaluation using a 95&#37; confidence interval &#40;CIs&#41;&#46; The combined OR values and 95&#37; CIs were calculated and visualized using a Forrest plot&#46; If <span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#44; the difference was considered significant&#46; Then a funnel plot was used to calculate the insecurity factor&#44; and the publication bias was quantitatively evaluated using RevMan 5&#46;3&#46;5 and Stata 15&#46;1 software&#46; Finally&#44; the stability of the evaluation results was evaluated using a sensitivity analysis&#46;</p></span></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">RESULTS</span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Combined effect analysis</span><p id="para80" class="elsevierStylePara elsevierViewall">A random-effects model was used to determine whether there was a significant difference in the effective remission rates for IBS patients with or without anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment&#46; As shown in <a class="elsevierStyleCrossRef" href="#fig3">Figure 3</a>&#44; the I<span class="elsevierStyleSup">2</span> value was 32&#37; suggesting a low degree of heterogeneity&#46; The combined OR was 2&#46;87 &#40;95&#37; CI&#58; 1&#46;74-4&#46;72&#41;&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;0001&#44; suggesting that anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment can effectively improve the clinical remission rates of IBS patients&#46;</p><elsevierMultimedia ident="fig3"></elsevierMultimedia></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Publication bias analysis</span><p id="para90" class="elsevierStylePara elsevierViewall">The publication bias was roughly evaluated using a funnel plot analysis&#46; The graphs on both sides of the funnel plot were symmetrical&#44; suggesting that publication bias had little impact on the results&#46; To plot the scatter plot&#44; the OR value was used as the abscissa and the SE&#40;log &#91;OR&#93;&#41; value as the ordinate &#40;<a class="elsevierStyleCrossRef" href="#fig4">Fig&#46; 4</a>&#41;&#46; The results showed that the effect value was relatively concentrated in the middle and upper parts of the graph&#44; with a roughly symmetrical shape&#44; indicating that publication bias was less likely to be the cause of any differences&#46; The Begg&#39;s method was used to quantitatively evaluate publication bias &#40;<a class="elsevierStyleCrossRef" href="#fig5">Fig&#46; 5</a>&#41;&#44; and produced a Z value of 1&#46;25&#44; Pr&#62;&#8739;Z&#8739;&#61;0&#46;210&#62;0&#46;05&#44; suggesting that there was no real publication bias in this study&#46;</p><elsevierMultimedia ident="fig4"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia></span><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Sensitivity analysis</span><p id="para100" class="elsevierStylePara elsevierViewall">Sensitivity analysis was performed using a fixed-effects and random-effects model&#44; which re-estimated the results by omitting one study to determine the effect of each individual study on the overall result &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46; This evaluation showed that the results of this study were relatively stable&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia></span></span><span id="cesec130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">DISCUSSION</span><p id="para110" class="elsevierStylePara elsevierViewall">A total of ten studies were included in this review&#44; and all ten evaluated the effective remission rates of the clinical symptoms &#40;abdominal pain&#44; diarrhea&#44; constipation&#44;&#41; in IBS patients who were receiving anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment and those who were not&#46; Seven studies demonstrated a positive effect and three reported a negative result&#46; The findings of the meta-analysis showed that anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment could effectively improve the clinical remission rates of IBS patients&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">As one of the most common pathogenic bacteria in the digestive system&#44; <span class="elsevierStyleItalic">H&#46; pylori</span> infections have been shown to be closely related with the development of chronic gastritis&#44; gastric ulcers&#44; and gastric cancer&#46; Various antigens and toxins produced by <span class="elsevierStyleItalic">H&#46; pylori</span> can cause cellular vacuolization&#44; mitochondrial dysfunction&#44; and endoplasmic reticulum-mediated stress&#44; all of which lead to the generation of oxidative stress&#44; which is recognized by the immune system and activates the transcriptional upregulation of pro-inflammatory cytokines and chemokines triggering a series of inflammatory responses &#40;<a class="elsevierStyleCrossRef" href="#bib16">16</a>&#44;<a class="elsevierStyleCrossRef" href="#bib17">17</a>&#41;&#46; <span class="elsevierStyleItalic">H&#46; pylori</span> can also activate the immune system via the brain-gut axis and via the regulation of gastrointestinal hormones&#44; resulting in increased secretion of gastrin&#44; cholecystokinin&#44; and other gastrointestinal hormones&#44; and increased activity of intestinal smooth muscle cells&#46; This leads to a series of intestinal symptoms including diarrhea and abdominal pain &#40;<a class="elsevierStyleCrossRef" href="#bib18">18</a>&#44;<a class="elsevierStyleCrossRef" href="#bib19">19</a>&#41;&#46; Several studies have shown that anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment can result in a change in intestinal flora often significantly decreasing the abundance of <span class="elsevierStyleItalic">Escherichia coli&#44;</span> while increasing that of <span class="elsevierStyleItalic">Klebsiella</span> and other Enterobacteriaceae &#40;<a class="elsevierStyleCrossRef" href="#bib20">20</a>&#44;<a class="elsevierStyleCrossRef" href="#bib21">21</a>&#41;&#46; But whether such changes aggravate or improve the clinical symptoms for IBS has not been evaluated&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">IBS is a functional gastrointestinal disease with unclear pathogenesis&#46; Some studies have shown that IBS patients may have low-grade inflammation and organ damage &#40;<a class="elsevierStyleCrossRef" href="#bib22">22</a>&#44;<a class="elsevierStyleCrossRef" href="#bib23">23</a>&#41;&#46; Some animal studies have found that intestinal microecology imbalances and disordered intestinal flora can induce Kupffer cell proliferation and TNF-&#945; and INF-&#947; expression&#44; which may result in liver cell damage &#40;<a class="elsevierStyleCrossRef" href="#bib24">24</a>&#44;<a class="elsevierStyleCrossRef" href="#bib25">25</a>&#41;&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">Studies have confirmed that the occurrence of IBS can be linked to increased activation of the gut-brain axis&#44; high visceral sensitivity&#44; intestinal flora changes&#44; and increased immune activation&#46; It is worth noting that intestinal flora changes may vary between regions and these changes are primarily characterized by significant decreases in <span class="elsevierStyleItalic">Bifidobacterium</span> and <span class="elsevierStyleItalic">Lactobacillus</span> in Chinese patients and a decrease in <span class="elsevierStyleItalic">Bifidobacteria</span> and an increase in <span class="elsevierStyleItalic">Bacteroides</span> in European patients &#40;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#44;<a class="elsevierStyleCrossRef" href="#bib27">27</a>&#41;&#46; Small intestine bacterial overgrowth &#40;SIBO&#41; is a condition characterized by the translocation of the distal intestinal flora to the small intestine in response to a variety of factors&#59; this results in the overgrowth of anaerobic bacteria&#44; which is responsible for the manifestation of a series of clinical symptoms&#46; Because of the overlap in clinical symptoms between SIBO and IBS&#44; SIBO is currently under investigation as one of the potential pathogenic routes to IBS&#46; In the meta-analysis&#44; more than one-third of the IBS patients were found to be positive for SIBO&#59; this is a significantly higher incidence than that observed in healthy individuals&#46; Female sex&#44; higher age&#44; and IBS-induced diarrhea were all associated with SIBO in individuals with IBS &#40;<a class="elsevierStyleCrossRef" href="#bib28">28</a>&#41;&#46; SIBO can alter the intestinal microenvironment by altering the inflammatory responses&#44; regulating the immune system&#44; intestinal mucosal permeability&#44; and gas production&#44; thereby validating the partial overlap between SIBO and IBS&#46; Our study also demonstrated that antibiotic therapy can partially alleviate the clinical manifestations of IBS&#59; this finding is in agreement with other literature&#44; which suggests that antibiotic therapy can significantly improve the clinical symptoms of IBS patients with SIBO &#40;<a class="elsevierStyleCrossRefs" href="#bib29">29&#8211;31</a>&#41;&#46; In addition&#44; several papers have demonstrated a link between SIBO and <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#46; Patients with <span class="elsevierStyleItalic">H&#46; pylori</span> are more likely to test positive for SIBO &#40;<a class="elsevierStyleCrossRef" href="#bib32">32</a>&#41;&#46; Further&#44; <span class="elsevierStyleItalic">H&#46; pylori</span> eradication therapy can effectively relieve the clinical symptoms of patients with SIBO &#40;<a class="elsevierStyleCrossRef" href="#bib33">33</a>&#41;&#44; which also suggests there is some correlation between <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#44; and SIBO and IBS&#46; Anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment may relieve the clinical symptoms of IBS by ameliorating SIBO&#46; However&#44; this aspect was not included in the original studies&#44; suggesting a need for additional studies that use bacterial culture to objectively demonstrate these interactions&#46; The intestinal mucosal immune system of IBS patients is characterized by a significant increase in the levels of lymphocytes &#40;T cells&#41; and mast cells&#44; resulting in an increased release of trypsin and histamine leading to abdominal pain &#40;<a class="elsevierStyleCrossRef" href="#bib34">34</a>&#44;<a class="elsevierStyleCrossRef" href="#bib35">35</a>&#41;&#46; Colon biopsies of post-infection IBS patients show that intestinal endocrine cells &#40;ECs&#41; increase more than five times in number&#44; while lamina propria T cells &#40;CD3&#44; CD4 and CD8&#41; double in number&#46; Meanwhile&#44; resident macrophage &#40;CD68&#41; populations are reduced by half and activated macrophage populations increase significantly&#46; Activated macrophages produce many pro-inflammatory cytokines&#44; including IL-1&#44; which further stimulate intestinal ECs to produce excessive 5-HT&#44; which may activate 5-HT mediated vagal afferent nuclei and increase the sensitivity of the emotional and autonomic neural networks in the brain&#46; The vagus nerve is an important part of the microbiome-gut-brain axis that conveys the sensory and microbial information from the gut to the brain&#46; The activation of inflammatory cells&#44; the increase in pro-inflammatory factors&#44; and the activation of the vagus nerve can lead to the development of diarrhea and visceral hypersensitivity &#40;<a class="elsevierStyleCrossRef" href="#bib36">36</a>&#41;&#46; All these factors can affect the nature and duration of intestinal inflammation&#46; Different individuals need different recovery times to restore their original balance&#44; and eventually&#44; some people will develop IBS &#40;<a class="elsevierStyleCrossRef" href="#bib37">37</a>&#44;<a class="elsevierStyleCrossRef" href="#bib38">38</a>&#41;&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall">Current studies suggest that IBS may be associated with <span class="elsevierStyleItalic">H&#46; pylori</span> infection &#40;<a class="elsevierStyleCrossRef" href="#bib39">39</a>&#44;<a class="elsevierStyleCrossRef" href="#bib40">40</a>&#41;&#46; A meta-analysis by L MR et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib41">41</a>&#41; suggested that <span class="elsevierStyleItalic">H&#46; pylori</span> infection rates in IBS patients were significantly higher than expected in a healthy population&#46; However&#44; a similar meta-analysis by Ng et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib42">42</a>&#41; showed that there was no clear evidence to support an association between IBS and <span class="elsevierStyleItalic">H&#46; pylori</span>&#59; however this may be attributed to the smaller sample size in this study&#46; Our results suggest that anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment could reduce IBS symptoms&#44; and this may be mediated by the effects of anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatments on gastrointestinal pH and flora changes&#44; thereby promoting the recovery of the intestinal mucosal immune system and the gut-brain axis and restoring the regulation of the gastrointestinal hormone system &#40;<a class="elsevierStyleCrossRef" href="#bib32">32</a>&#41;&#46; The specific mechanism underlying these effects is not yet clear&#44; and further experiments are needed&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">A key limitation of this is study the subjective outcome evaluation of the included literature&#44; which fails to specify the detailed amelioration of clinical symptoms&#44; such as abdominal pain&#44; diarrhea&#44; and constipation&#46; Therefore&#44; more accurate scales need to be used to effectively quantify the clinical outcomes&#46; The development of these tools would facilitate stronger evidence-based conclusions in the future&#46; It is necessary to point out the fact that the lack of <span class="elsevierStyleItalic">H&#46; pylori</span> eradication in the experimental group is not the result of ineffective anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment but rather owing to the fact that the treatment was aimed at preventing infection instead of eradicating the bacteria&#46; This qualification should be more apparent in clinical trials and the effect of a preventative treatment should be evaluated in additional clinical trials&#46; In addition&#44; because of the limited sample size&#44; the clinical remission rate could not be compared between different subgroups of IBS&#44; suggesting that these findings should be validated in larger populations&#46;</p></span><span id="cesec140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">AUTHOR CONTRIBUTIONS</span><p id="para170" class="elsevierStylePara elsevierViewall">Xiong Y&#44; Zhou X contributed to study design&#46; Xiong Y contributed in literature search&#44; analysys and draft writing&#46; Xiong Y&#44; Liu L&#44; Zhou X&#44; Wang R&#44; Wen Y contributed in literature screening&#46; Xion Y&#44; Liu L&#44; Zhou X contributed in data extraction</p></span></span>"
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          "titulo" => "INTRODUCTION"
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          "titulo" => "MATERIAL AND METHODS"
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              "titulo" => "Inclusion and exclusion criteria"
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              "titulo" => "Exclusion criteria"
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              "titulo" => "Retrieval strategies"
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              "titulo" => "Data extraction"
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              "titulo" => "Quality evaluation and Risk-of-bias assessments"
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              "titulo" => "Statistical analysis"
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        3 => array:3 [
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          "titulo" => "RESULTS"
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              "titulo" => "Combined effect analysis"
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            1 => array:2 [
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              "titulo" => "Publication bias analysis"
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            2 => array:2 [
              "identificador" => "cesec120"
              "titulo" => "Sensitivity analysis"
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        4 => array:2 [
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          "titulo" => "DISCUSSION"
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          "titulo" => "AUTHOR CONTRIBUTIONS"
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          "titulo" => "ACKNOWLEDGMENTS"
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        7 => array:1 [
          "titulo" => "REFERENCES"
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    "fechaRecibido" => "2020-03-31"
    "fechaAceptado" => "2020-07-10"
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          "palabras" => array:4 [
            0 => "Irritable Bowel Syndrome"
            1 => "<span class="elsevierStyleItalic">Helicobacter Pylori</span> Infection"
            2 => "IBS treatment"
            3 => "Meta-analysis"
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Here we used a meta-analysis of several clinical trials to determine whether anti-<span class="elsevierStyleItalic">Helicobacter pylori</span> therapy has any positive effect on IBS patients&#46; Here we compared the effective clinical remission rates between IBS patients treated with anti-<span class="elsevierStyleItalic">H&#46; pylori</span> therapy and those who were not&#46; This data would provide more clinical evidence regarding the efficacy of novel treatments and intervention points for IBS patients&#46;</p><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Relevant studies were identified using keyword searches on various electronic databases&#44; including PubMed&#44; Embase&#44; the Cochrane Central Register of Controlled Trials&#44; CNKI&#44; and CBM&#46; Keywords included &#8220;<span class="elsevierStyleItalic">helicobacter pylori</span>&#8221; and &#8220;irritable bowel syndrome&#8221; among others&#46; The literature was screened using relatively strict inclusion and exclusion criteria and RevMan 5&#46;3&#46;5 and Stata 15&#46;1 software were used for meta-analysis and to assess publication bias and sensitivity&#46;</p><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">A total of ten studies met all of the inclusion criteria&#59; these included 655 IBS patients with <span class="elsevierStyleItalic">H&#46; pylori</span> infection&#44; of these&#44; 385 patients were in the experimental group and 270 patients were in the control group&#46; A random-effects model was used to pool the odds ratios &#40;ORs&#41; with a 95&#37; confidence interval &#40;CIs&#41; and the combined OR was 2&#46;87 &#40;95&#37; CI&#58; 1&#46;74-4&#46;72&#41;&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;0001&#46; These findings suggest that anti-<span class="elsevierStyleItalic">H&#46; pylori</span> therapy can effectively improve the remission rates of <span class="elsevierStyleItalic">H&#46; pylori-</span>positive IBS patients&#46;</p><p id="spara110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">H&#46; pylori</span> infection is known to correlate with the incidence of IBS&#46; Anti-<span class="elsevierStyleItalic">H&#46; pylori</span> treatment can effectively improve the clinical remission rates of IBS patients&#46; Whether this means that IBS patients should be actively treated with anti-<span class="elsevierStyleItalic">H&#46; pylori</span> compounds as a novel strategy to improve the remission rates needs to be evaluated <span class="elsevierStyleItalic">in vivo</span>&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">Errata</p> <p class="elsevierStyleNotepara" id="cenpara20">CLINICS 2021&#59;76&#58;e1857err</p> <p class="elsevierStyleNotepara" id="cenpara30">Erratum for&#58; doi&#58; <span class="elsevierStyleInterRef" id="interrefs10" href="https://doi.org/10.6061/clinics/2020/e1857">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;6061&#47;clinics&#47;2020&#47;e1857</span>&#44; published in 2020&#46;</p> <p class="elsevierStyleNotepara" id="cenpara40">Replace the corresponding author&#58; Yan Xiong</p> <p class="elsevierStyleNotepara" id="cenpara50">For&#58; Xuchun Zhou&#42;</p> <p class="elsevierStyleNotepara" id="cenpara60">No potential conflict of interest was reported&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">IBS Diagnostic criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Hp detection method&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Number in experimental groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Number in control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">The number of cases effectively alleviated in the experimental group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Number of cases of effective remission in the control group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Statistical significance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">NOS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xiong F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yu DH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lu SM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Qu TS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shi J&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li XQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yang LQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yang Y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yuan ZP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Han H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rome III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UBT&#43;RUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">Basic information describing the studies included in the meta-analysis&#46;</p>"
        ]
      ]
      6 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sensitivity analysis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Number of articles&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Z value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">OR value&#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Random-effects model&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;87 &#40;1&#46;74&#44;4&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fixed-effects model&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;00001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;86 &#40;1&#46;95&#44;4&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Random-effects model without the XIONG et al&#46; study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;00001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;29 &#40;1&#46;97&#44;5&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fixed-effects model without the XIONG et al&#46; study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;00001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;37 &#40;2&#46;19&#44;5&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara70" class="elsevierStyleSimplePara elsevierViewall">Sensitivity analysis&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:42 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of epidemiological investigation of irritable bowel syndrome in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              XQ Li \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              M Chang \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Xu \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              XC Fang \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Chin J Gastroenterol Hepatol"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "numero" => "8"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;kns&#46;cnki&#46;net&#47;kcms&#47;detail&#47;detail&#46;aspx&#63;dbcode&#61;CJFD&#38;dbname&#61;CJFD2013&#38;filename&#61;WCBX201308007&#38;v&#61;PbadWf99Cc9WJtIJvcda35t5&#37;25mmd2FpITkglBr2UKIBXg9QfMhqI1kfiN98qNnkNe0V7A"
                      ]
                    ]
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                ]
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            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Irritable bowel syndrome&#58; the clinical approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              A Adriani \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DG Ribaldone \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              M Astegiano \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Durazzo \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              GM Saracco \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              R Pellicano \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
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                              AYS Soh \n
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                              """
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        "texto" => "<p id="para180" class="elsevierStylePara elsevierViewall">We would like to acknowledge the funding received from the Medical Research Project of the Chongqing Health and Family Planning Commission &#40;No&#46; 2016MSXM002&#41; and the TCM Science and Technology Project of the Chongqing Health and Family Planning Commission &#40;No&#46; ZY201802081&#41;&#46;</p>"
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos