Meta-Analysis: The Treatment of Irritable Bowel Syndrome

Conclusion

Despite welcome improvements in trial design and robustness of studies for the newer therapeutic agents for IBS, evaluation of traditional treatments is hampered by poor methodology and inconclusive findings. Many of the treatments currently used in IBS are of dubious efficacy.

The results of our meta-analysis are summarized in the Table 2 . We give a grade A evidence-based recommendation for the use of tegaserod for IBS with constipation in women and alosetron for women with severe IBS with diarrhoea who have failed on conventional therapy. Antidepressants are recommended for IBS with diarrhoea patients with severe refractory symptoms. Loperamide can be recommended in patients with painless diarrhoea.

There is not enough evidence to recommend the use of bulking agents in the treatment of constipation, except as adjuvants in patients with painless constipation. Most trials with antispasmodics were methodologically flawed, and the clinical evidence supporting their use is weak. We do not recommend the use of stimulating laxatives, peppermint oil, prokinetic agents or benzodiazepines in the treatment of IBS.

Elimination diet cannot be recommended except in patients with proven food intolerance. Current studies do not support the routine use of probiotics in IBS patients and large, placebo-controlled trials need to be performed. Finally, the role for psychotherapy in IBS is not established.

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The authors wish to thank Frances Weir, Thomson Acumed, for editorial support on the manuscript. The editorial assistance was funded by Novartis Pharma AG.

Aliment Pharmacol Ther. 2004;20(11) © 2004 Blackwell Publishing

Cite this: Meta-Analysis: The Treatment of Irritable Bowel Syndrome - Medscape - Dec 01, 2004.