Systematic Review and Meta-analysis: Efficacy of Mesalamine in Irritable Bowel Syndrome

Management of Irritable Bowel Syndrome With Diarrhea

“…Two large RCTs 140,141 including patients with IBS and IBS-D and 1 small trial including patients with IBS-D 142 evaluated the effect of a 12-week course of mesalazine, concluding that this therapy was not superior to placebo for the amelioration of abdominal pain, bloating, or defecation frequency, although patients with postinfection IBS were those most likely responding to mesalazine. However, a recent updated meta-analysis pooling a total of 8 RCTs and 820 patients concluded that mesalazine was more efficacious than placebo for global IBS symptoms (RR of global symptoms not improving, 0.86; 95% CI, 0.79-0.95; number needed to treat, 10; 95% CI, 6-27), but not for abdominal pain or bowel habit or stool frequency; interestingly, subanalyses according to IBS subtype demonstrated efficacy for global IBS symptoms only for IBS-D (RR, 0.88; 95% CI, 0.79-0.99) 65 …”

“…63 The second study assessed the effect of a nonviable probiotic lysate (Escherichia coli DSM17252and Enterococcus faecalis DSM16440), which showed in the posthoc analysis to confer a benefit on patients with IBS-D in terms of abdominal pain response over time and stool consistency, although no differences with placebo have been highlighted for EMA endpoints. 64 A recent meta-analysis assessing probiotic efficacy in IBS, 65 according to patients with IBS-D included 13 RCTs of combination probiotics that were able to induce an overall improvement of global symptoms (RR, 0.78; 95% CI, 0.67-0.92), while the single strains most studied were all Lactobacillus strains, again with a significant improvement in global symptoms (RR, 0.57; 95% CI, 0.36-0.89).…”

“…However, a recent updated meta-analysis pooling a total of 8 RCTs and 820 patients concluded that mesalazine was more efficacious than placebo for global IBS symptoms (RR of global symptoms not improving, 0.86; 95% CI, 0.79-0.95; number needed to treat, 10; 95% CI, 6-27), but not for abdominal pain or bowel habit or stool frequency; interestingly, subanalyses according to IBS subtype demonstrated efficacy for global IBS symptoms only for IBS-D (RR, 0.88; 95% CI, 0.79-0.99). 65 FMT FMT, which is the transfer of the intestinal microbiota from a healthy donor into the gastrointestinal tract of a patient with dysbiosis, has been investigated in the setting of IBS in the last decade, 143 to restore and target dysbiosis associated with IBS. 144 Two different meta-analyses on the use of FMT in IBS reported discordant results: Myneedu and colleagues failed to find a significant effect of FMT over control (RR, 0.93; 95% CI, 0.50-1.75), whereas Ianiro and colleagues confirmed the absence of a significant effect of FMT (RR, 0.98; 95% CI, 0.58-1.66) but also observed that FMT via colonoscopy was superior to placebo, although only 2 trials were included in this subanalysis.…”

“…A recent meta-analysis assessing probiotic efficacy in IBS, 65 according to patients with IBS-D included 13 RCTs of combination probiotics that were able to induce an overall improvement of global symptoms (RR, 0.78; 95% CI, 0.67-0.92), while the single strains most studied were all Lactobacillus strains, again with a significant improvement in global symptoms (RR, 0.57; 95% CI, 0.36-0.89).…”

Probiotics in the Treatment of Irritable Bowel Syndrome in General Practice: A Real-World Narrative Review

“…As a consequence of these latter findings, a manipulation of the microbiota has been proposed decades ago as a useful tool in the treatment of IBS [8] and growing evidence supports the effect of probiotics, that is "live microorganisms which when administered in adequate amounts confer a health benefit on the host" (well-known even before the pioneering studies of Elia Metchnikoff at the beginning of the 20th century: see for example Deuteronomy 32:14 where fermented milk is cited as a beneficial food given by God to humanity) in this regard [9][10][11]. Moreover, research on probiotics has been recently enclosed in the 10-item list of top research priorities in IBS [12] and in fact controlled clinical trials, meta-analyses and reviews regarding the efficacy of probiotics in IBS abound in the literature [13][14][15][16][17]. These are truly powerful research tools, but their results do not always reflect what happens in the real world both because they are derived from a minority of the IBS population since the majority is cared for in primary care [18,19] and because their effects may not influence the prescribing attitudes of general practitioners [20].…”