Irritable Bowel Syndrome Remains a Difficult Condition to Manage

Nicholas J. Talley, MD, PhD

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In This Article

Tegaserod

Tegaserod, a partial 5-HT4 receptor agonist, is a prokinetic agent that has been extensively tested in patients who have IBS with constipation.[39] Randomized controlled trials of high quality have demonstrated significant improvement of global IBS symptoms over placebo, with a 5% to 19% therapeutic gain ( Table 4 ).[40,41,42,43] In a Cochrane systematic review of 7 trials, the number needed to treat was calculated to be 17.[44] A reported adverse event with tegaserod therapy is diarrhea, which occurs about twice as often in tegaserod-treated patients as in those taking placebo. However, only 1% to 2% of patients taking tegaserod in the clinical trials discontinued the medication because of diarrhea. In a meta-analysis, the number needed to harm in terms of diarrhea was 20.[44]

In IBS with diarrhea, tegaserod did not cause more diarrhea than placebo.[45] The role of intermittent tegaserod therapy is unclear, and the value of long-term maintenance therapy also has not been demonstrated. Long-term safety has appeared acceptable over 12 months.[46] The rates of abdominal surgery were similar in IBS patients using tegaserod versus placebo in a recent systematic review[47]; use of the drug in patients who previously have had abdominal surgery has not been a clinical issue. The efficacy of tegaserod in men has not been established.

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