You Don’t Need Prescription Meds to Treat IBS

Irritable bowel syndrome, or IBS, is a common, distressing disorder of the intestines producing one or more of the following: abdominal cramping pain, bloating, intestinal gas, and diarrhea or constipation (sometimes both). Effective prescription medications have been introduced recently – alosetron (Lotronex®) and Lubiprostone (Amitiza®) – but many patients can be treated successfully by simpler methods that address the principal symptoms. The effectiveness of three such approaches has been reported in the British Medical Journal, using meta-analysis of numerous published studies.

Twelve studies were identified that compared fiber intake with a placebo or no treatment at all. They included 590 patients, 20% to 90% of whom were women. The specific fiber used in 6 of the studies was ispaghula husk, or psyllium. In these, 64% of the placebo or no treatment patients had persistent symptoms during and after treatment. With the psyllium treatment, only 52% had continued symptoms, so that there was a 13% reduction in frequency of persistent symptoms. The number-needed-to-treat was 6. Bran showed no benefit over placebo.

Twenty-two studies examined the effectiveness of 12 different antispasmodic drugs, in 1775 patients. Overall, 56% of the placebo patients in these studies had persistent symptoms during and after treatment, compared with 39% given antispasmodics, representing a reduction of 32%, and a number-needed-to-treat of 5. The most effective antispasmodics were otilonium (not available in the USA) and hyoscine (Buscopan®).

Finally, 4 studies compared peppermint oil with placebo, in 390 patients. Of those taking the peppermint oil, 25% had persistent IBS symptoms, compared with 65% of the placebo patients. This shows a reduction in symptoms of 57%, on average, and a number-needed-to-treat of 2.5.

These meta-analyses showed clearly that all 3 selected treatments were effective in IBS, with peppermint oil as the best, antispasmodics as second best, and added fiber in third place. Remember that there are other approaches to management, without necessarily involving prescription medications – e.g. dietary modification (avoiding gas-producing foods, adding more fiber), and symptomatic treatment of diarrhea (loperamide or Imodium®) or constipation (laxatives). There are many excellent web sites about IBS, but be careful – not all treatments are well-tested, and most ‘cures’ are expensive and don’t work. One of the better sites is that of the IFFGD.