Interventions for the Treatment of Irritable Bowel Syndrome: A Review of Cochrane Systematic Reviews

Abstract

BACKGROUND: Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder, whose understanding is relatively uncertain, and the treatment guidance decision still represents a challenge. OBJECTIVE: To identify and critically appraise systematic reviews (SRs) published in the Cochrane Database of SRs (CDSR) on the effects of interventions (pharmacological and non-pharmacological) for the treatment of IBS. METHODS: The search was conducted at the Cochrane Library in May 2020. The methodological quality of the SRs was evaluated by the AMSTAR-2 tool. RESULTS: Eight SRs with moderate to high quality were included, which addressed the treatments: (a) pharmacological: volume agents, antispasmodics, antidepressants and tegaserod; and (b) non-pharmacological: homeopathy, acupuncture, phytotherapy, biofeedback, psychological interventions and hypnotherapy. The results were favorable to antispasmodic drugs and antidepressants regarding the improvement of clinical symptoms. There was no difference between volume agents or tegaserod when compared to placebo. Acupuncture and homeopathy showed a little improvement in symptoms compared to placebo, but the certainty of this evidence was considered low to very low. Psychological interventions seem to improve the overall assessment of the patient and relief symptoms such as abdominal pain. However, there was no long-term follow-up of these patients. The results of the other treatments were considered uncertain due to the high risk of bias. CONCLUSION: Considering the low quality of the studies included in the SRs, pharmacological treatment with antispasmodics and antidepressants seems to be beneficial for patients with IBS. Among non-pharmacological interventions, psychological interventions seem to be beneficial. However, further clinical trials are recommended with greater methodological rigor to prove these findings.

A Systematic Review on the Efficacy and Safety of Selective Serotonin Reuptake Inhibitors in Gastrointestinal Motility Disorders: More Control, Less Risk

“…They included two RCTs including 306 patients with an odds ratio of 0.94 in those administered escitalopram and p<0.05 [13,14]; four systematic reviews each studying six to 15 RCTs with greater significance and low risk of bias [9,[15][16][17] and two meta-analyses [5,10]. One of which included seven RCTs with 346 patients comparing SSRI treatment with placebo treatment and showed that 54.5% (96/176) patients with SSRI trial demonstrated improvement in their symptoms (I²=49%, p=0.07) [5].…”

“…This study only includes pain symptoms and cannot provide conclusive evidence for the relief of global symptoms of IBS. Scaciota et al published data emphasizing the efficacy of antidepressants (TCAs and SSRIs) in IBS in their systematic review [ 17 ]. They studied 15 RCTs, of which 11 RCTs with 750 subjects were interpreted for an overall assessment of relief, and the results were RR=1.57, 95% CI=1.23-2.0.…”

The lived experience of irritable bowel syndrome: A focus on dietary management

“…2 Proposed mechanisms of IBS include psychological factors, miscommunication between the gut and central nervous system, dysmotility, altered mucosal immune and inflammatory function, genetic susceptibility, infection and gastroenteritis, alterations in gut microbiota and visceral hypersensitivity. [3][4][5] A recent survey estimated an IBS prevalence of 3.5% in Australia and 4.1% globally. 6 It is more prevalent in women, particularly those aged 18-39 years.…”

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

“… 157 In an overview of Cochrane systematic reviews, taking the poor quality of the primary studies into consideration, only antispasmodics and antidepressants appear to be beneficial of all the pharmacological treatments proposed, while psychological therapy would be the only beneficial treatment among the non-pharmacological interventions. 158 …”