Older simpler treatments effective for IBS

A recent article in the British Medical Journal (BMJ), reported on by the BBC, has suggested that old and often overlooked treatments for Irritable Bowel Syndrome (IBS) may be as effective as newer medications.

Older treatments for IBS, such as peppermint oil and soluble fibre, are often recommended by patient experts, but are frequently overlooked or not considered properly by gastroenterologists. The supposed lack of scientific evidence for the use of these treatments, particularly when compared to modern medications, is one reason for this. The BBC has quoted a "UK expert" as saying that there had been a general feeling among doctors that the therapies "didn't work".

A group of researchers led by Dr Alex Ford, a gastroenterologist who has recently moved from Canada - where he did the research - to St James University Hospital in Leeds, carried out a systematic review and retrospective analysis of randomised controlled trials, and their results were published in the BMJ this month.

They looked at randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with IBS. In total, the trials included considered more than 2,500 patients.

The effect of therapy compared with placebo or no treatment was reported as the relative risk of symptoms persisting.

Twelve studies compared fibre with placebo or no treatment in 591 patients. They found that the relative risk of persistent symptoms was less with treatment instead of with placebo or no treatment. This beneficial effect was limited to ispaghula, a form of soluble fibre supplement and was not seen when using bran, a form of insoluble fibre. [1]

Twenty two trials compared antispasmodics with placebo in 1778 patients. Various antispasmodics were studied, but otilonium and hyoscine showed consistent evidence of efficacy. [1] Hyoscine was the most successful antispasmodic drug looked at and, according to the BBC, the researchers said this should be the first choice out of the antispasmodics.

Four trials compared peppermint oil with placebo in 392 patients, with results also showing a decreased risk of symptoms persisting with treatment.

The conclusion of the researchers was that:.

"Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome."

Both peppermint oil and hyoscine - an antispasmodic which is not currently widely prescribed in the UK - are available from the pharmacy and isphagula husks or other forms of soluble fibre supplement are widely available in health food stores.

For more information on the use of this kind of treatment for IBS, the book 'IBS: The First Year', by American patient-expert Heather Van Vorous may be helpful.

References:

1. Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, Moayyedi P. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008 Nov 13;337:a2313. doi: 10.1136/bmj.a2313.