The American College of Gastroenterology (ACG) has issued a new systematic review regarding the management of irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). This analysis appears in the American Journal of Gastroenterology and updates the most recent systematic reviews on IBS from 2009 and CIC from 2005.
The primary objective of the meta-analysis was to assess the efficacy of currently available treatments for IBS and CIC vs. placebo or no treatment. Secondary objectives were the assessment of the efficacy of currently available treatments in treating IBS according to predominant stool pattern reported (IBS with constipation, IBS with diarrhea, and mixed IBS) and assessment of adverse events with treatments for both IBS and CIC. Studies on adults >16 years of age that included any definition of IBS or CIC were included. Eligible trials were required to include one or more of the following outcome measures:
- Global assessment of improvement in IBS or CIC symptoms
- Improvement in abdominal pain for IBS
- Global IBS symptom or abdominal pain scores for IBS
- Mean number of stools per week during therapy for CIC
After identifying and evaluating the relevant research, new treatment recommendations were issued. Highlights of the new IBS treatment recommendations include:
- Special elimination diets may be effective, but existing evidence is lacking.
- Fiber may be helpful in relieving IBS symptoms; there is greater evidence in support of an effect of psyllium compared to bran for IBS.
- There is insufficient evidence of effect with prebiotics and synbiotics in IBS.
- Probiotics improve global symptoms, bloating, and flatulence in IBS.
- Rifaximin, a poorly absorbed antibiotic, has moderate evidence in support of effectiveness in IBS with diarrhea.
- Linaclotide and lubiprostone have strong recommendations for IBS with constipation.
- There is better evidence to support the use of antidepressants and psychological therapies in IBS compared to the past.
Highlights of the new CIC treatment recommendations include:
- A strong recommendation for fiber supplements use in CIC is given.
- Laxatives (including polyethylene glycol [PEG], lactulose, sodium picosulfate, and bisacodyl) have strong recommendations for the treatment of CIC.
- Prucalopride, lubiprostone, and linaclotide have been given strong recommendations for treatment of CIC.
While these scientifically-based recommendations are designed to provide a framework for gastroenterologists in treating IBS and CIC, therapies may need to be tailored to the individual patients, the authors add. Open communication between the patient and physician regarding symptoms is essential for effective treatment as well.
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