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Prescribing Advice for GPs

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Systematic Review of IBS treatments

The British Medical Journal has published the results of a systematic review and meta-analysis of studies assessing the efficacy of treatments for irritable bowel syndrome (IBS). The results have also been reported in the general media (BBC).

The review identified 35 studies that were of the required quality and provided the data necessary for the analysis. These studies included trials of antispasmodics, fibre supplements and peppermint oil.

Fibre reduced the risk of persistent symptoms however the effect was limited to ispaghula (Hazard Ratio 0.78, 95% CI 0.63 to 0.96). Studies of antispasmodics revealed consistent evidence of efficacy for hyoscine (HR 0.63, 95% CI 0.51 to 0.78) but the evidence for mebeverine was poor based on a single study of 80 patients. Peppermint oil was also found to be beneficial (HR 0.43, 95% CI 0.32 to 0.59).

The authors conclude that, "fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome".

Action: Clinicians will be reassured by the results of this review of IBS treatments. In particular, it appears that ispaghula, hyoscine and peppermint oil offer the most effective treatment options.

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