Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial

Bijkerk, C.J.; Wit, Niek J. de; Muris, Jean; Whorwell, Peter J.; Knottnerus, J. A.; Hoes, Arno W.

doi:10.1136/bmj.b3154

Cited by 258 publications

(142 citation statements)

References 29 publications

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“…The study results were in concordance to the previously published literature where osmotic and bulk laxatives were used in relieving the constipation-related symptoms in patients with IBS-C and FC. 35,36 However, the point to highlight here is that, only 36.6% patients of FC and 50.9% patients of IBS-C were on laxative therapy. Moreover, about 1/5 th patients of FC were using home remedies for the same.…”

Section: Discussionmentioning

confidence: 90%

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Rooprai

Bhat

Sainani³

et al. 2017

Int J Basic Clin Pharmacol

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Background: Evaluate prevalence of functional constipation (FC) and irritable bowel syndrome-constipation (IBS-C) in Indian constipated patients and assess their demographic/socio-economic/clinical characteristics.Methods: Patients (≥18 years) who visited their general physician with symptoms of constipation (Rome III criteria for FC or IBS-C as per physician assessment) and willing to participate were enrolled in this prospective, clinical-epidemiological study. Demographic, socioeconomic status, lifestyle and dietary habits, comorbid conditions, treatment history, concomitant medications, stool form (Bristol stool form scale), severity of constipation (constipation scoring system [CSS]), constipation-related symptoms (patient assessment of constipation symptoms [PAC-SYM]) and quality of life (patient assessment of constipation-quality of life questionnaire [PAC-QoL]) were recorded.Results: Out of 925 constipated patients, 75.6% were diagnosed with FC against 24.4% with IBS-C (P < 0.0001). Patients of both subtypes had high average scores of PAC-SYM (FC: 27.1 ± 6; IBS-C: 30.1 ± 4.9) and CSS (FC: 8.4 ± 3.1; IBS-C: 11.2 ± 3), leading to high PAC-QoL score (FC: 38.1 ± 16.8; IBS-C: 42.2 ± 13.6). Hypertension (16%) and diabetes (10%) in patients with FC while acid peptic disorders (21.7%) amongst IBS-C patients were the most common comorbid conditions observed. Laxatives were the most common medication used; osmotic (32.6% versus 40.7%) and bulk laxatives (22.8% versus 37.4%) were the commonest laxatives. However, about 1/5th patients of FC were using home remedies.Conclusions: There was a higher prevalence of FC over IBS-C in Indian constipated patients; both subtypes had high frequency and severity of constipation-related symptoms and poor QoL.

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Section: Discussionmentioning

confidence: 90%

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Rooprai

Bhat

Sainani³

et al. 2017

Int J Basic Clin Pharmacol

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“…Poleca się także redukcję spożycia tłuszczy, surowych warzyw, owoców i napojów z kofeiną. Udowodniono, że stosowanie psyllium istotnie zmniejsza nasilenie objawów choroby w odróżnieniu od otrębów, które nie zmniejszają dolegliwości w IBS [16]. Badanie zakładało stosowanie 10 g psyllium w porównaniu z 10 g otrębów lub placebo przez okres 12 tyg.…”

Section: Postępowanieunclassified

Irritable bowel syndrome – a new approach to aetiopathogenesis

Nehring¹,

Mrozikiewicz-Rakowska²,

Krasnodębski³

et al. 2011

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“…[46] Some investigators have reported that insoluble fibre worsens pain and bloating in IBS, but the trials included in the systematic review did not report data in such a way that this issue could be examined. • For GRADE evaluation of interventions for Irritable bowel syndrome, see table, p 37 .…”

Section: Commentmentioning

confidence: 99%

“…However, the additional RCT included in this review was conducted in primary care. [46] OPTION • For GRADE evaluation of interventions for Irritable bowel syndrome, see table, p 37 .…”

Section: Commentmentioning

confidence: 99%

“…[65] However, all but one RCT in these two reviews are >10 years old, and do not meet basic methodological quality standard criteria [39] [40] deducted for the inclusion of different types of antidepressant and assessment tool used Quality points deducted for short follow-up and heterogeneity of trials. Consistency point deducted for different results with different drugs in the same class Very low 0 0 -1 -2 4 Antispasmodic drugs versus placebo Symptom improvement 22 (at least 1828) [38] [42] [43] [44] Quality points deducted for short follow-up and methodological flaws in the RCTs included in the review Low 0 0 0 -2 4 Peppermint oil versus placebo Symptom improvement 5 (at least 482) [38] [42] [45] Quality point deducted for sparse data Moderate 0 0 0 -1 4 Peppermint oil versus placebo Quality of life 1 (90) [45] Quality points deducted for short follow-up, heterogeneity of studies, and other methodological flaws in the RCTs included in the reviews Very low 0 0 0 -3 4 Soluble fibre versus placebo Symptom improvement 5 (at least 596) [38] [42] [46] High 0 0 0 0 4 Soluble fibre versus placebo Quality of life 1 (275) [46] Quality points deducted for short follow-up and other methodological flaws in the RCTs included in the review Low 0 0 0 -2 4 Insoluble fibre versus placebo Symptom improvement 6 (at least 519) [42] [38] [46] High 0 0 0 0 4 Insoluble fibre versus placebo Quality of life 1 (275) [46] Quality points deducted for short follow-up and heterogeneity of studies. Directness point deducted for uncertainty about generalisability of results Very low 0 -1 0 -2 4 Tegaserod versus placebo Symptom improvement 11 (9242) [47] Quality points deducted for short follow-up and heterogeneity of studies.…”

Section: Commentmentioning

confidence: 99%

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Irritable Bowel Syndrome

Ford

Martin

Talley

2010

Evidence‐Based Gastroenterology and Hepatology

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INTRODUCTION: The prevalence of irritable bowel syndrome (IBS) varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%. IBS is associated with abnormal gastrointestinal motor function and enhanced visceral perception, as well as psychosocial and genetic factors. People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with IBS? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5HT 3 receptor antagonists (alosetron and ramosetron), 5HT 4 receptor agonists (tegaserod), antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors [SSRIs]), antispasmodics (including peppermint oil), cognitive behavioural therapy (CBT), hypnotherapy, loperamide, and soluble and insoluble fibre supplementation. QUESTIONS To be covered in future updates Probiotics Key points• The key features of irritable bowel syndrome (IBS) are chronic, recurrent abdominal pain or discomfort, associated with disturbed bowel habit, in the absence of any structural abnormality to account for these symptoms.The prevalence of IBS varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%.IBS is associated with abnormal GI motor function, enhanced visceral perception, abnormalities in central pain processing, and altered gut flora, as well as psychosocial and genetic factors.People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS.A positive symptom-based diagnosis and a graded general treatment approach are cornerstones in the management of people with IBS.• Antidepressants (tricyclic antidepressants and SSRIs) may reduce global symptoms of IBS and abdominal pain compared with placebo.• Antispasmodics (including peppermint oil) may reduce global symptoms of IBS and abdominal pain compared with placebo.• We don't know whether soluble fibre supplementation (ispaghula) is more effective than placebo at improving global symptoms or abdominal pain in IBS as the data are contradictory.• Insoluble fibre supplementation does not reduce global symptoms o...

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Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial

Abstract: Objective To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome.

Cited by 258 publications

References 29 publications

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Prevalence of functional constipation and constipation-predominant irritable bowel syndrome in Indian patients with constipation

Irritable bowel syndrome – a new approach to aetiopathogenesis

Irritable Bowel Syndrome

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