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Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis.
Am J Gastroenterol 2019; 114(1):21-39AJ

Abstract

OBJECTIVES

Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain-gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective.

METHODS

We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidepressants versus placebo, or psychological therapies versus control therapy or "usual management" were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI).

RESULTS

The search strategy identified 5316 citations. Fifty-three RCTs, reported in 51 separate articles, were eligible for inclusion: 17 compared antidepressants with placebo, 35 compared psychological therapies with control therapy or "usual management", and one compared both psychological therapy and antidepressants with placebo. Four of the trials of psychological therapies, and one of the RCTs of antidepressants, were identified since our previous meta-analysis. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57-0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs, although with heterogeneity between RCTs of the latter (I = 49%, P = 0.07). The RR of symptoms not improving with psychological therapies was 0.69 (95% CI 0.62-0.76). Cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy were all beneficial when data from two or more RCTs were pooled. There was significant heterogeneity between studies (I = 69%, P < 0.001) and significant funnel plot asymmetry. There were also issues regarding trial design, including lack of blinding.

CONCLUSIONS

Antidepressants are efficacious in reducing symptoms in IBS patients. Psychological therapies also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result.

Authors+Show Affiliations

Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.Division of Gastroenterology and Hepatology, Mayo School of Medicine, Scottsdale, AZ, USA.Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA.Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30177784

Citation

Ford, Alexander C., et al. "Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: an Updated Systematic Review and Meta-Analysis." The American Journal of Gastroenterology, vol. 114, no. 1, 2019, pp. 21-39.
Ford AC, Lacy BE, Harris LA, et al. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019;114(1):21-39.
Ford, A. C., Lacy, B. E., Harris, L. A., Quigley, E. M. M., & Moayyedi, P. (2019). Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. The American Journal of Gastroenterology, 114(1), pp. 21-39. doi:10.1038/s41395-018-0222-5.
Ford AC, et al. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: an Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019;114(1):21-39. PubMed PMID: 30177784.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. AU - Ford,Alexander C, AU - Lacy,Brian E, AU - Harris,Lucinda A, AU - Quigley,Eamonn M M, AU - Moayyedi,Paul, PY - 2018/9/5/pubmed PY - 2018/9/5/medline PY - 2018/9/5/entrez SP - 21 EP - 39 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 114 IS - 1 N2 - OBJECTIVES: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain-gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective. METHODS: We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidepressants versus placebo, or psychological therapies versus control therapy or "usual management" were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). RESULTS: The search strategy identified 5316 citations. Fifty-three RCTs, reported in 51 separate articles, were eligible for inclusion: 17 compared antidepressants with placebo, 35 compared psychological therapies with control therapy or "usual management", and one compared both psychological therapy and antidepressants with placebo. Four of the trials of psychological therapies, and one of the RCTs of antidepressants, were identified since our previous meta-analysis. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57-0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs, although with heterogeneity between RCTs of the latter (I = 49%, P = 0.07). The RR of symptoms not improving with psychological therapies was 0.69 (95% CI 0.62-0.76). Cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy were all beneficial when data from two or more RCTs were pooled. There was significant heterogeneity between studies (I = 69%, P < 0.001) and significant funnel plot asymmetry. There were also issues regarding trial design, including lack of blinding. CONCLUSIONS: Antidepressants are efficacious in reducing symptoms in IBS patients. Psychological therapies also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/30177784/Effect_of_Antidepressants_and_Psychological_Therapies_in_Irritable_Bowel_Syndrome:_An_Updated_Systematic_Review_and_Meta_Analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=30177784 DB - PRIME DP - Unbound Medicine ER -