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18 July 2000 | Volume 133 Issue 2 | Pages 136-147
Purpose: To evaluate the efficacy of pharmacologic agents for the irritable bowel syndrome.
Data Sources: Electronic literature search of MEDLINE (1966 to 1999), EMBASE (1980 to 1999), PsycINFO (1967 to 1999), and the Cochrane controlled trials registry and a manual search of references from bibliographies of identified articles.
Study Selection: Randomized, double-blind, placebo-controlled, parallel, or crossover trials of a pharmacologic intervention for adult patients that reported outcomes of improvement in global or irritable bowel–specific symptoms.
Data Extraction: Qualitative and quantitative data reported on study groups, interventions, treatment outcomes, and trial methodologic characteristics.
Data Synthesis: 70 studies met the inclusion criteria. The most common medication classes were smooth-muscle relaxants (16 trials), bulking agents (13 trials), prokinetic agents (6 trials), psychotropic agents (7 trials), and loperamide (4 trials). The strongest evidence for efficacy was shown for smooth-muscle relaxants in patients with abdominal pain as the predominant symptom. Loperamide seems to reduce diarrhea but does not relieve abdominal pain. Although psychotropic agents were shown to produce global improvement, the evidence is based on a small number of studies of suboptimal quality. Psychotropic drugs, 5-hydroxytryptamine (5-HT)–receptor antagonists, peppermint oil, and Chinese herbal medicine require further study.
Conclusions: Smooth-muscle relaxants are beneficial when abdominal pain is the predominant symptom. In contrast, the efficacy of bulking agents has not been established. Loperamide is effective for diarrhea. Evidence for use of psychotropic agents is inconclusive; more high-quality trials of longer duration are needed. Evidence for the efficacy of 5-HT–receptor antagonists seems favorable, although more studies are needed.
Author and Article Information
From The Regenstrief Institute for Health Care, Indiana University School of Medicine, and the Richard. L Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
Acknowledgment: The authors thank Thomas Emmett, MD, MLS, for assistance with the electronic database searches.
Grant Support: By National Research Service Award T32 PE15001 from the Health Resources and Services Administration and by National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Disease) Career Development Award 1 K24 DK 02756-01 (Dr. Imperiale).
Requests for Single Reprints: Thomas F. Imperiale, MD, Health Services Research and Development, Route 11-H, Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Dr. Jailwala: Division of Gastroenterology, Froedtert Hospital, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226.
Dr. Imperiale: Health Services Research and Development, Route 11-H, Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202.
Dr. Kroenke: Regenstrief Institute for Health Care, 1050 Wishard Boulevard, RG 6, Indianapolis, IN 46202. REVIEW
Pharmacologic Treatment of the Irritable Bowel Syndrome
A Systematic Review of Randomized, Controlled Trials
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