Meta-Analysis: The Treatment of Irritable Bowel Syndrome

D. Lesbros-Pantoflickova; P. Michetti; M. Fried; C. Beglinger; A. L. Blum

Disclosures

Aliment Pharmacol Ther. 2004;20(11) 

In This Article

Editor's Note

Please note: The following announcement supersedes any information contained in this article. On March 30, 2007, Novartis, in compliance with an FDA request, suspended marketing and sales of its irritable bowel/constipation drug tegaserod maleate (Zelnorm) after an analysis of its clinical database pointed to a higher incidence of myocardial infarction, stroke, and unstable angina among patients taking the drug. For updated information on this issue, see the Medscape Alert Center on tegaserod.

Summary and Introduction

Summary

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.

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder characterized by recurrent abdominal pain/discomfort, bloating and stool irregularities (constipation and/or diarrhoea). IBS can be classified on the basis of the primary bowel symptom, so there is IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D) and IBS with alternating symptoms of constipation and diarrhoea (IBS-A).

The IBS is estimated to affect 10-15% of the Western population, although rates vary according to the criteria being used.[1] IBS, like many other poorly understood disorders, is viewed as a multifactorial disorder (Figure 1). Symptoms and clinical outcomes may depend on the interaction of several pathogenetic factors including genetics,[2,3,4] early life events,[5] postinflammatory changes after GI infections,[6] psychosocial impact[7] and food.[8]

Epidemiology of Irritable Bowel Syndrome (IBS) and Factors Influencing Health Care Seeking.

Despite low rates of health care-seeking behaviour, IBS accounts for 28% of gastroenterology practice[9] and 12% of primary care caseloads.[10] IBS has major economic impact, both in terms of health care utilization, as well as absenteeism and reduced quality of life in patients not seeking care. The need for effective treatments to combat the multiple symptoms of IBS is thus a matter of considerable interest and importance.

The aim of the present review was to evaluate therapies available for the treatment of IBS, and provide consensus recommendations for their use. We focused mainly on pharmacotherapy, but the efficacy of non-drug options such as exclusion diet, probiotics and psychotherapy in the treatment of IBS is also discussed.

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