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Meta-analysis: The treatment of irritable bowel syndrome.

Abstract

To evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double-blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5-point scale. Meta-analyses were performed on all studies, and on 'high-quality studies'. The efficacy of fibre in the global irritable bowel syndrome symptoms relief (OR: 1.9; 95% CI:1.5-2.4) was lost after exclusion of low-quality trials (OR: 1.4; 95% CI: 1.0-2.0, P = 0.06). When excluding the low-quality trials, an improvement of global irritable bowel syndrome symptoms with all antispasmodics (OR: 2.1; 95% CI:1.8-2.9) was maintained only for octylonium bromide, but on the basis of only two studies. Antidepressants were effective (OR: 2.6, 95% CI: 1.9-3.5), even after exclusion of low-quality studies (OR: 1.9, 95% CI: 1.3-2.7). Alosetron (OR: 2.2; 95% CI: 1.9-2.6) and tegaserod (OR: 1.4; 95% CI: 1.2-1.5) showed a significant effect in women. We recommend the use of tegaserod for women with irritable bowel syndrome with constipation and alosetron for women with severe irritable bowel syndrome with diarrhoea. Antidepressants can be beneficial for irritable bowel syndrome with diarrhoea patients with severe symptoms. Loperamide can be recommended in painless diarrhoea. Evidence is weak to recommend the use of bulking agents in the treatment of irritable bowel syndrome with constipation.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, University Hospital of Lausanne, Lausanne, Switzerland. lesbrosdraha@yahoo.fr

    , , ,

    Source

    Alimentary pharmacology & therapeutics 20:11-12 2004 Dec pg 1253-69

    MeSH

    Antidiarrheals
    Drug Design
    Gastrointestinal Agents
    Humans
    Irritable Bowel Syndrome
    Parasympatholytics
    Psychotherapy
    Serotonin Agents

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15606387

    Citation

    Lesbros-Pantoflickova, D, et al. "Meta-analysis: the Treatment of Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics, vol. 20, no. 11-12, 2004, pp. 1253-69.
    Lesbros-Pantoflickova D, Michetti P, Fried M, et al. Meta-analysis: The treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20(11-12):1253-69.
    Lesbros-Pantoflickova, D., Michetti, P., Fried, M., Beglinger, C., & Blum, A. L. (2004). Meta-analysis: The treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 20(11-12), pp. 1253-69.
    Lesbros-Pantoflickova D, et al. Meta-analysis: the Treatment of Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2004;20(11-12):1253-69. PubMed PMID: 15606387.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Meta-analysis: The treatment of irritable bowel syndrome. AU - Lesbros-Pantoflickova,D, AU - Michetti,P, AU - Fried,M, AU - Beglinger,C, AU - Blum,A L, PY - 2004/12/21/pubmed PY - 2005/6/4/medline PY - 2004/12/21/entrez SP - 1253 EP - 69 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 20 IS - 11-12 N2 - To evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double-blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5-point scale. Meta-analyses were performed on all studies, and on 'high-quality studies'. The efficacy of fibre in the global irritable bowel syndrome symptoms relief (OR: 1.9; 95% CI:1.5-2.4) was lost after exclusion of low-quality trials (OR: 1.4; 95% CI: 1.0-2.0, P = 0.06). When excluding the low-quality trials, an improvement of global irritable bowel syndrome symptoms with all antispasmodics (OR: 2.1; 95% CI:1.8-2.9) was maintained only for octylonium bromide, but on the basis of only two studies. Antidepressants were effective (OR: 2.6, 95% CI: 1.9-3.5), even after exclusion of low-quality studies (OR: 1.9, 95% CI: 1.3-2.7). Alosetron (OR: 2.2; 95% CI: 1.9-2.6) and tegaserod (OR: 1.4; 95% CI: 1.2-1.5) showed a significant effect in women. We recommend the use of tegaserod for women with irritable bowel syndrome with constipation and alosetron for women with severe irritable bowel syndrome with diarrhoea. Antidepressants can be beneficial for irritable bowel syndrome with diarrhoea patients with severe symptoms. Loperamide can be recommended in painless diarrhoea. Evidence is weak to recommend the use of bulking agents in the treatment of irritable bowel syndrome with constipation. SN - 0269-2813 UR - https://www.unboundmedicine.com/medline/citation/15606387/Meta_analysis:_The_treatment_of_irritable_bowel_syndrome_ L2 - https://doi.org/10.1111/j.1365-2036.2004.02267.x DB - PRIME DP - Unbound Medicine ER -