Update on Pharmacotherapy for Irritable Bowel Syndrome

Munjal, Akhil; Dedania, Bhavtosh; Cash, Brooks D.

doi:10.1007/s11894-019-0692-7

Cited by 16 publications

(5 citation statements)

References 37 publications

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“…While various pharmalogical treatments are available to alleviate the symptoms of IBS, such as tricyclic antidepressants, antispasmodics and selective serotonin reuptake inhibitors, non-pharmalogical options are needed in order to improve efficacy of treatment and mitigate the risk of adverse events. 59 Probiotics, prebiotics and synbiotics are potentially promising approaches of altering gut microbiota and alleviating symptoms of functional bowel disorders. The current article presents a systematic review and meta-analysis of recent RCTs evaluating the efficacy and safety of probiotics, prebiotics and synbiotics in the context of IBS.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

Asha¹,

Khalil

2020

Sultan Qaboos Univ Med J

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Treatments that target alterations in gut microbiota may be beneficial for patients with irritable bowel syndrome (IBS). A systematic review and meta-analysis was conducted of randomised clinical trials (RCTs) evaluating the efficacy and safety of probiotics, prebiotics and synbiotics. Factors considered in the analysis included global IBS symptoms and/or abdominal pain, secondary symptoms and the frequency of adverse events. A total of 33 RCTs involving 4,321 patients were identified. Overall, probiotics significantly improved global IBS symptoms compared to placebos (standardised mean difference = −0.32, 95% confidence interval: −0.48 to −0.15; P <0.001), with significant heterogeneity between studies (I2 = 72%; P <0.001). This remained apparent in both single- and multi-strain probiotic interventions as well as synbiotic formulations. However, evidence regarding prebiotics was scarce. There were no significant inter-group differences in terms of the frequency of adverse events. Future RCTs should address methodological limitations, including short follow-up periods and patient adherence.Keywords: Irritable Bowel Syndrome; Gastrointestinal Microbiome; Dietary Supplements; Probiotics; Prebiotics; Synbiotics; Meta-Analysis; Systematic Review.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

Asha¹,

Khalil

2020

Sultan Qaboos Univ Med J

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“…In contrast, American Gastroenterological Association guidelines give a conditional recommendation for TCAs (low quality of evidence) but conditionally recommend against SSRIs for IBS (low quality of evidence) [8]. Notably, none of the eight drugs that have received US Food and Drug Administration (FDA) approval for IBS (alosetron, eluxadoline, linaclotide, lubiprostone, rifaximin, plecanatide, tegaserod, and tenapanor) or European Medicines Agency (EMA)-approved drugs (eluxadoline and linaclotide) have antidepressant properties [9]. Low-grade inflammation, bile acid malabsorption, dysmotility, and gut microbiome dysbiosis have important roles in the etiology of IBS [7,10,11].…”

Section: Introductionmentioning

confidence: 99%

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

Takakura

Rezaie

2020

JCM

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Irritable bowel syndrome (IBS) is a common disorder requiring complex, multidisciplinary management. Antidepressants are commonly used and recommended in guidelines for the treatment of patients with IBS. We assessed randomized controlled trials (RCTs) on antidepressants in patients with IBS, with specific attention to study design and data quality/reporting characteristics. Following a comprehensive search, data and RCT characteristics were systematically summarized. Fragility index, representing the number of positive “events” that the study relies on for its significance, was calculated. Eighteen RCTs were included. Overall, tricyclic antidepressants (TCAs), but not selective serotonin reuptake inhibitors (SSRIs), appeared to be efficacious in IBS. Eight studies reported on adverse events (AEs), which were significantly greater in patients receiving antidepressants versus placebo. The median (mean) fragility index of TCA trials was 0 (1.5). RCTs with positive results had significantly lower placebo rates (20.8%) versus negative studies (45.7%; p < 0.0001). RCTs exhibited limitations related to study design (sample size and blinding), data analysis (outcomes and placebo response), and data reporting (selective reporting of AEs and publication bias). Careful consideration of limitations of RCTs on antidepressants in IBS is warranted to formulate a safe and beneficial treatment regimen for patients with IBS.

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“…The latter is due to a series of problems: for instance, notwithstanding an abundant literature, to date no validated therapeutic algorithm is available for IBS. Moreover, the huge variation in symptoms complained by these patients accounts for the great variability reported in the responses to identical therapeutic approaches; this leads to various recommended treatments for the same symptoms [2]. It should be also taken into account the fact that the various treatments employed for IBS patients may be limited by the appearance of adverse events, in turn leading to safety concerns [3].…”

Section: Introductionmentioning

confidence: 99%

What can be done pharmacologically for a subject with severe refractory constipation-predominant irritable bowel syndrome?

Bassotti

2020

Expert Opinion on Pharmacotherapy

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Update on Pharmacotherapy for Irritable Bowel Syndrome

Cited by 16 publications

References 37 publications

Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

Efficacy and Safety of Probiotics, Prebiotics and Synbiotics in the Treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis

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

What can be done pharmacologically for a subject with severe refractory constipation-predominant irritable bowel syndrome?

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