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Evidence summaries

Pharmacological Treatment of the Irritable Bowel Syndrome

Smooth muscle relaxants appear to be effective for abdominal pain, and loperamide for diarrhoea. Level of evidence: "B"

A systematic review 1 including 70 studies with a total of 4 836 subjects was abstracted in DARE. Bulking agents: 3 of the 7 high-quality RCTs reported benefit. Smooth muscle relaxants: 13 of 16 RCTs (including all the 7 high-quality RCTs) reported benefit. Prokinetic agents: 2 of 6 RCTs (one of 4 high-quality RCTs) reported benefit. Loperamide: All 4 RCTs reported an improvement in diarrhoea, and the 2 RCTs that assessed global status improvement reported benefit. Psychotropic agents: 3 of the 5 RCTs reported global improvement, and 4 of the 7 reported improvement in abdominal pain, but none reported any difference in constipation. Ondansetron (2 RCTs) showed some benefit.

Comment: The quality of evidence is downgraded by potential reporting bias.

References

  • Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med 2000 Jul 18;133(2):136-47. [PubMed] [DARE]

Primary/Secondary Keywords