Self-Reported Use of Pharmaceuticals Among Patients With Irritable Bowel Syndrome in Primary Care

Abstract

BACKGROUND: Irritable bowel syndrome (IBS) has an estimated 10%-12% prevalence in industrial countries. Studies from the United States have shown that IBS causes notable financial losses for employers. Due to the lack of pathophysiological markers, only a fraction of the pharmacological management of IBS has focused on etiological mechanisms. We hypothesized that there is a high consumption of nonspecific drugs among patients with IBS in their attempts to manage symptoms.OBJECTIVE: To analyze self-reported use of prescription and over-thecounter (OTC) drugs among patients with IBS in primary care compared with controls from the general population.METHODS: A population-based case-control design was used for the study. IBS cases were identified from the electronic medical records of 3 Swedish primary health care centers from January 1, 1997, through December 31, 2001. A questionnaire containing specific questions about prescription and OTC drugs was mailed in 2003 to 5,015 working-age (18-64 years) individuals (IBS cases and controls) in the Linköping IBS Population Study, a study of primary care patients with controls selected from the general population. RESULTS: After 2 reminders, the overall response rate was 63% (3,074 respondents of 4,913 deliverable surveys); 71% responded for the IBS cases (347/486) and 57% (2,509/4,427) responded for the controls. 72.3% of the IBS respondents and 51.9% of the controls were female. Acid-suppressive agents were the most commonly cited drug category for abdominal complaints reported by IBS patients (13.3%) compared with controls (1.6%) (unadjusted odds ratio [OR] = 9.20, 95% confidence interval [CI] = 5.94-14.25). Antidepressants were the most commonly cited drug category for nonabdominal complaints, reported by 13.3% of IBS patients versus 4.5% of controls (OR = 3.27, 95% CI = 2.27-4.70). An unadjusted univariate correlation analysis revealed that prescription acid-suppressive drugs, fiber and bulking laxatives, and antiflatulents and antidiarrhea drugs, as well as motility-regulating and antispasmodics drugs, were significantly more common among IBS cases compared with controls. In addition to the higher use of antidepressants, there were 3 other drug classes for nongastrointestinal complaints with a higher rate of use among IBS patients compared with controls: sedative hypnotics (OR = 2.49, CI = 1.44-4.29), analgesics (OR = 2.86, CI = 1.88-4.33), and thyroid hormones (OR = 2.43, CI = 1.39-4.26).CONCLUSIONS: There was higher use of antidepressants among patients with IBS compared with controls from the general population. Even though they are not recommended for this patient category, the use of prescription and OTC acid-suppressive drugs is also common among IBS cases in primary care.

Alterations in serotonin metabolism in the irritable bowel syndrome

“…fasting or (meal) stimulated condition, expression and activity of SERT, reuptake of serotonin within the gut and transport of serotonin in liver, lungs and platelets and presence of concurrent psychopathology in IBS patients such as anxiety and depression . Interpretation of published data on human serotonin metabolism in IBS is further hampered by factors such as sample processing, the analytical technique used, small sample size studies, the heterogeneous nature of IBS, imbalance in distribution among IBS subtypes, sampling in fasting vs. post‐prandial state, presence of psychopathology and use of drugs prescribed for IBS that modify GI function or the 5‐HT system . Large studies are needed, preferably from well‐characterised IBS patient groups that assess parameters of 5‐HT metabolism taking into account IBS subtypes and potential confounding factors.…”

Anaesthetic antacids: a review of its pharmacological properties and therapeutic efficacy

“…17 A similar study on 374 patients in Sweden showed that acid-suppressive agents were the most commonly used drugs for abdominal complaints by IBS patients, for nonabdominal complaints, 13.3% of IBS patients selfmedicated with antidepressants. 18 According to a previous study, antacids were regularly prescribed during the high-dose steroid therapy to prevent gastritis, and in this context, oxethazaine-antacid is expected to provide greater pain relief and control of symptoms in gastritis. Given the fact that IBS has broad range of physiological and psychological alterations, the optimal treatment strategy for its management has yet to be identified.…”

Tianeptine vs amitriptyline for the treatment of irritable bowel syndrome with diarrhea: a multicenter, open‐label, non‐inferiority, randomized controlled study

“…Patients with IBS have higher levels of depression, anxiety, and somatoform disorders than healthy persons or patients with organic disease 8 . The use of antidepressants in patients with IBS is three times higher than in controls in the general population 9 . Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat IBS.…”

“…8 The use of antidepressants in patients with IBS is three times higher than in controls in the general population. 9 Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat IBS. While SSRIs are used in IBS-C because of their prokinetic effect, TCAs are effective in IBS-D because they prolong whole-gut transit times.…”