Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome.

@article{Ruepert2011BulkingAA,
  title={Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome.},
  author={Lisa Ruepert and A. Otto Quartero and Niek J. de Wit and Geert J.M.G. van der Heijden and Greg P Rubin and Jean W.M. Muris},
  journal={The Cochrane database of systematic reviews},
  year={2011},
  volume={8},
  pages={
          CD003460
        }
}
BACKGROUND Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. The role of pharmacotherapy for IBS is limited and focused mainly on symptom control. OBJECTIVES The objective of this systematic review was to evaluate the efficacy of bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. SEARCH STRATEGY Computer assisted structured searches of MEDLINE, EMBASE, The Cochrane library, CINAHL and PsychInfo were conducted for the… 

Figures and Tables from this paper

Eluxadoline Versus Antispasmodics in the Treatment of Irritable Bowel Syndrome: An Adjusted Indirect Treatment Comparison Meta-analysis

TLDR
A network meta-analysis showed that eluxadoline 100 mg was at least as effective as antispasmodics in relieving abdominal pain in IBS, but elUXadoline had more reported adverse events.

Shortcomings of Trials Assessing Antidepressants in the Management of Irritable Bowel Syndrome: A Critical Review

TLDR
Overall, tricyclic antidepressants, but not selective serotonin reuptake inhibitors (SSRIs), appeared to be efficacious in IBS, with specific attention to study design and data quality/reporting characteristics.

INTERVENTIONS FOR THE TREATMENT OF IRRITABLE BOWEL SYNDROME: A REVIEW OF COCHRANE SYSTEMATIC REVIEWS.

TLDR
Considering the low quality of the studies included in the SRs, pharmacological treatment with antispasmodics and antidepressants seems to be beneficial for patients with IBS, and among non-pharmacological interventions, psychological interventions seem to bebeneficial.

The role of fi ber supplementation in the treatment of irritable bowel syndrome : a systematic review and meta-analysis

TLDR
Soluble fiber appears to improve symptoms of IBS, whereas there is no evidence for recommending insoluble fiber for IBS.

Different interventions for the treatment of irritable bowel syndrome-adjusted indirect comparison

TLDR
Herbal medicine may be more effective than western active medicine for the treatment of irritable bowel syndrome, especially in relieving the global symptoms, which may help the clinicians to make a decision in routine practice.

Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis

TLDR
It is suggested that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high and future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials.

[Pharmacotherapy for irritable bowel syndrome in the context of evidence-based medicine].

TLDR
To choose pharmacotherapy for IBS in each specific case is a challenge as this is determined by the form of IBS, the availability of an approved medicine on the domestic market, the indications for use, possible long-term use, high safety, and efficacy evidence drawn from RPCTs.

Mirtazapine in diarrhea-predominant irritable bowel syndrome: an open label study.

TLDR
In this open-label study, mirtazapine demonstrated efficacy in improving both gastrointestinal and psychological symptoms in IBS-D, and its potential utility should be further evaluated in larger controlled trials.

Efficacy of pinaverium bromide in the treatment of irritable bowel syndrome: a systematic review and meta-analysis

TLDR
Pinaverium is superior to placebo for the treatment of IBS symptoms, irrespective of patient age or gender, study publication year, sample size, or MQS, among the lowest for studies and meta-analyses of antispasmodics versus placebo in IBS.
...

References

SHOWING 1-10 OF 246 REFERENCES

Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis.

TLDR
It is concluded that low dose TCAs exhibit clinically and statistically significant control of IBS symptoms.

Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis

TLDR
Antidepressants are effective in the treatment of IBS and there is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.

How do SSRIs help patients with irritable bowel syndrome?

TLDR
The results showed that citalopram was superior to placebo in terms of the primary outcome measure—days with abdominal pain—and this improvement was unrelated to change in mood, change in stool pattern, or the effect of intravenous citalsopram on rectal distension thresholds.

Antidepressants for irritable bowel syndrome

TLDR
Recent meta-analyses of the cumulative controlled experience confirm the efficacy of antidepressants in IBS and other functional gastrointestinal disorders: only 3–4 patients require treatment to demonstrate a benefit over placebo—numbers indicating a solid treatment effect.

Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis

TLDR
The role of peppermint oil in the symptomatic treatment of IBS has so far not been established beyond reasonable doubt, and a metaanalysis of five placebo-controlled, double blind trials seems to support this notion.

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

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

Meta‐analysis: the treatment of irritable bowel syndrome

TLDR
Evidence is weak to recommend the use of bulking agents in the treatment of irritable bowel syndrome with constipation, but antidepressants can be beneficial for patients with severe symptoms and loperamide can be recommended in painless diarrhoea.

Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials.

TLDR
The strongest evidence for efficacy was shown for smooth-muscle relaxants in patients with abdominal pain as the predominant symptom, and loperamide seems to reduce diarrhea but does not relieve abdominal pain.

Open-label treatment with citalopram in patients with irritable bowel syndrome: a pilot study.

TLDR
Results of this pilot study suggest that large controlled trials are needed to further evaluate the efficacy of SSRIs such as citalopram for the treatment of IBS.

A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome

TLDR
The SSRI citalopram significantly improves IBS symptoms, including abdominal pain, compared with placebo, and the therapeutic effect is independent of effects on anxiety, depression, and colonic sensorimotor function.
...