Meta‐analysis: the treatment of irritable bowel syndrome

Lesbros-Pantoflickova, Drahoslava; Michetti, Pierre; Fried, Michael; Beglinger, Christoph; Blum, A. L.

doi:10.1111/j.1365-2036.2004.02267.x

Cited by 177 publications

(132 citation statements)

References 193 publications

(195 reference statements)

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“…In another meta-analysis of 13 placebo-controlled studies, fiber was found to improve global symptoms of IBS. But after exclusion of low-quality studies, the result did not reach statistical significance [122] . Abnor mal bacterial fer mentation and disturbed gas handling may also cause bloating and abdominal pain and may worsen clinical outcome [141] .…”

Section: Bulking Agentsmentioning

confidence: 94%

“…mebeverine, pinaverine, octylonium bromide). Most studies of smooth muscle relaxants have been hindered by poor study design, high drop-out rates, and low patient enrollment which have made assessment of their therapeutic value in IBS difficult [121][122][123] . In a recent meta-analysis, only octylonium bromide was found to have some benefit after excluding poor quality studies [122] .…”

Section: Antispasmodicsmentioning

confidence: 99%

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Updates on treatment of irritable bowel syndrome

Hammerle¹,

Surawicz²

2008

WJG

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Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated to affect 10%-15% of the Western population, and has a large impact on quality of life and (in)direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and postinfectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications (alosetron and tegaserod) because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologicallybased overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.

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Section: Bulking Agentsmentioning

confidence: 94%

Section: Antispasmodicsmentioning

confidence: 99%

Updates on treatment of irritable bowel syndrome

Hammerle¹,

Surawicz²

2008

WJG

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“…Most published studies have shown that TCAs improve the symptoms in FGID patients; however, the quality and design of these trials has been variable. [44][45][46][47][48] Of the three recent meta-analyses that have evaluated the possible beneficial effects of TCAs on functional GI symptoms, two concluded that such treatments were beneficial, 49,50 while one concluded that they were not superior to placebo, for the treatment of IBS. 51 Jackson et al 49 were of poor quality and that TCAs were not superior to placebo for global GI symptom improvement.…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

Review article: modulation of the brain–gut axis as a therapeutic approach in gastrointestinal disease

Mayer¹,

Tillisch²,

Bradesi³

2006

Aliment Pharmacol Ther

121

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SummaryBackgroundThe importance of bi‐directional brain‐gut interactions in gastrointestinal illness is increasingly being recognized, most prominently in the area of functional gastrointestinal disorders. Numerous current and emerging therapies aimed at normalizing brain–gut interactions are a focus of interest, particularly for irritable bowel syndrome and functional dyspepsia.MethodsA literature search was completed for preclinical and clinical studies related to central modulation of gastrointestinal functions and published in English between 1980 and 2006.ResultsExisting data, while sparse, support the use of different classes of antidepressant drugs, including tricyclics, and selective and non‐selective serotonin reuptake inhibitors in irritable bowel syndrome. Serotonin receptor agonists and antagonists with peripheral and possibly central effects are effective in treating specific subtypes of irritable bowel syndrome. Based largely on theoretical and preclinical evidence, several novel compounds that selectively target receptors at multiple levels within the brain–gut axis such as neurokinin, somatostatin and corticotropin‐releasing factor receptor antagonists are promising.ConclusionsThis review discusses the rationale for modulation of the brain–gut axis in the treatment of functional gastrointestinal disorders and highlights the most promising current and future therapeutic strategies.

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“…[20][21][22] These trials are characterized by a low methodological quality and the heterogeneity of the populations recruited in these trials, leading to contradictory conclusions. 23 Antispasmodic efficacy to improve abdominal pain in IBS remains a matter of debate. To avoid these methodological criticisms, our study was designed in accordance with the 'points to consider' on the evaluation of drugs for the treatment of IBS and followed the recommended criteria for methodological good quality.…”

Section: Discussionmentioning

confidence: 99%