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Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis.

Abstract

OBJECTIVE

To determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Embase, and the Cochrane controlled trials register up to April 2008. Review methods Randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome were eligible for inclusion. The minimum duration of therapy considered was one week, and studies had to report either a global assessment of cure or improvement in symptoms, or cure of or improvement in abdominal pain, after treatment. A random effects model was used to pool data on symptoms, and the effect of therapy compared with placebo or no treatment was reported as the relative risk (95% confidence interval) of symptoms persisting.

RESULTS

12 studies compared fibre with placebo or no treatment in 591 patients (relative risk of persistent symptoms 0.87, 95% confidence interval 0.76 to 1.00). This effect was limited to ispaghula (0.78, 0.63 to 0.96). Twenty two trials compared antispasmodics with placebo in 1778 patients (0.68, 0.57 to 0.81). Various antispasmodics were studied, but otilonium (four trials, 435 patients, relative risk of persistent symptoms 0.55, 0.31 to 0.97) and hyoscine (three trials, 426 patients, 0.63, 0.51 to 0.78) showed consistent evidence of efficacy. Four trials compared peppermint oil with placebo in 392 patients (0.43, 0.32 to 0.59).

CONCLUSION

Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome.

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  • Authors+Show Affiliations

    ,

    Gastroenterology Division, McMaster University, Health Sciences Centre, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada. alexf12399@yahoo.com

    , , , , ,

    Source

    BMJ (Clinical research ed.) 337: 2008 Nov 13 pg a2313

    MeSH

    Adult
    Dietary Fiber
    Humans
    Irritable Bowel Syndrome
    Parasympatholytics
    Plant Oils
    Randomized Controlled Trials as Topic
    Treatment Outcome
    United States

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    19008265

    Citation

    Ford, Alexander C., et al. "Effect of Fibre, Antispasmodics, and Peppermint Oil in the Treatment of Irritable Bowel Syndrome: Systematic Review and Meta-analysis." BMJ (Clinical Research Ed.), vol. 337, 2008, pp. a2313.
    Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008;337:a2313.
    Ford, A. C., Talley, N. J., Spiegel, B. M., Foxx-Orenstein, A. E., Schiller, L., Quigley, E. M., & Moayyedi, P. (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ (Clinical Research Ed.), 337, pp. a2313. doi:10.1136/bmj.a2313.
    Ford AC, et al. Effect of Fibre, Antispasmodics, and Peppermint Oil in the Treatment of Irritable Bowel Syndrome: Systematic Review and Meta-analysis. BMJ. 2008 Nov 13;337:a2313. PubMed PMID: 19008265.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. AU - Ford,Alexander C, AU - Talley,Nicholas J, AU - Spiegel,Brennan M R, AU - Foxx-Orenstein,Amy E, AU - Schiller,Lawrence, AU - Quigley,Eamonn M M, AU - Moayyedi,Paul, Y1 - 2008/11/13/ PY - 2008/11/15/pubmed PY - 2008/12/17/medline PY - 2008/11/15/entrez SP - a2313 EP - a2313 JF - BMJ (Clinical research ed.) JO - BMJ VL - 337 N2 - OBJECTIVE: To determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, and the Cochrane controlled trials register up to April 2008. Review methods Randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome were eligible for inclusion. The minimum duration of therapy considered was one week, and studies had to report either a global assessment of cure or improvement in symptoms, or cure of or improvement in abdominal pain, after treatment. A random effects model was used to pool data on symptoms, and the effect of therapy compared with placebo or no treatment was reported as the relative risk (95% confidence interval) of symptoms persisting. RESULTS: 12 studies compared fibre with placebo or no treatment in 591 patients (relative risk of persistent symptoms 0.87, 95% confidence interval 0.76 to 1.00). This effect was limited to ispaghula (0.78, 0.63 to 0.96). Twenty two trials compared antispasmodics with placebo in 1778 patients (0.68, 0.57 to 0.81). Various antispasmodics were studied, but otilonium (four trials, 435 patients, relative risk of persistent symptoms 0.55, 0.31 to 0.97) and hyoscine (three trials, 426 patients, 0.63, 0.51 to 0.78) showed consistent evidence of efficacy. Four trials compared peppermint oil with placebo in 392 patients (0.43, 0.32 to 0.59). CONCLUSION: Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/19008265/full_citation L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=19008265 DB - PRIME DP - Unbound Medicine ER -