Comparison of the Therapeutic Effect of Wheat Bran, Mebeverine and Placebo in Patients with the Irritable Bowel Syndrome

Abstract

There is no generally accepted treatment in the irritable bowel syndrome (IBS), probably because of a lack of convincing therapeutic trials. In the present study, 120 outpatients with IBS participated in a prospective randomized therapeutic trial. According to a double-blind design, 40 patients received 400 mg/day mebeverine and 40 patients received a placebo. In an open branch of the trial, 40 patients were treated with 15 g/day wheat bran. The effects of treatment on symptoms were noted after 4, 8, 12 and 16 weeks of therapy. A significantly superior symptomatic effect of bran in comparison to mebeverine and placebo was demonstrated after 12 weeks, but could not be confirmed at the end of the study. There was no significant difference between the symptomatic effect of mebeverine and placebo. The compliance with the therapy was about 80% for 4 weeks, but dropped to about 50% at the end of the trial. This points to a particular difficulty in the management of patients with IBS. The results of this trial suggest that bran and mebeverine are no ideal therapy for patients with IBS but they support the therapeutic use of bran in patients with IBS.

IBS and the role of otilonium bromide

“…A European systematic review [66] identified nine placebo-controlled studies [71][72][73][74][75][76][77][78][79], but many did not use standardized diagnostic criteria and all were of low to intermediate quality since they were performed before the development of the Rome criteria for study design [80]. Abdominal pain was improved in seven of the studies [71,72,[74][75][76][77]79], bowel symptoms improved significantly versus placebo in two studies [77,79], and four reported global symptom severity improvement [71][72][73]76]. The authors concluded that there is sufficient evidence that antispasmodics may improve abdominal pain, but lack of evidence to support global symptom improvement [66].…”

Dietary treatment of the irritable bowel syndrome

“…Various lines of evidence suggest that fiber supplementation may lead to deterioration in a proportion of patients, certainly in the secondary and tertiary care settings. Of the nine controlled trials addressing this issue, seven have found that fiber supplementation was not helpful in IBS patients [42][43][44][45][46][47][48][49][50]. One uncontrolled study of 100 patients with IBS reported that although 10 improved with fiber supplementation, 55 deteriorated, with bowel disturbance being adversely affected most often, followed by abdominal distension and pain [51].…”

Evaluation of drug treatment in irritable bowel syndrome

“…It is contentious whether dietary fibre improves the symptoms of IBS [19][20][21][22][23][24][25][26][27][28][29] although some limited trial data suggest constipation will benefit. However, gas may be increased and any effect on pain is equivocal with bran or bulking agents [30].…”