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Peppermint oil, soluble fibre and older antispasmodics effective in irritable bowel syndrome (IBS)




A recent review of research into irritable bowel syndrome treatment finds that older drugs and nutritional interventions are highly effective.

The meta-analysis of randomized controlled trials was conducted for the American College of Gastroenterology by a team of British researchers. The College is working on new evidence-based recommendations for the treatment of irritable bowel syndrome (IBS). Their updated document is due to be published eearly this year.

What came out of the study is confirmation that peppermint oil, soluble fibre, and antispasmodics are all effective in treating the symptoms of IBS and should be considered first-line treatments for what is the most commonly diagnosed but poorly understood gastroenterological condition.

The study was conducted by a team led by Alexander C. Ford, MD, lecturer in medicine and honorary specialist registrar in gastroenterology at St. James's University Hospital in Leeds, England. Dr. Ford said of the results: "These remedies are cheap, effective and, some are available over the counter and should be considered first-line treatment in primary care."

The results of the analysis are timely as newer drugs which it was hoped would offer more effective IBS treatment have had to be withdrawn or have their use limited due to side-effects and safety concerns. For example, Zelnorm was voluntarily withdrawn from the US market after the FDA found a link to heart attacks and strokes. Another drug, Lotronex, a potent and selective 5-HT3 antagonist that was meant to be prescribed just for women with diarrhea, was pulled off the US market in 2000 after killing several women, but was subsequently re-introduced.

Many of these newer drugs act on receptors for the neurotransmitter serotonin (5-HT) in the gut which research has shown are likely to play a central role in IBS. Clearly the current drugs on offer carry high risks however so safer alternatives are needed.

In their study Dr. Ford and colleagues analyzed trials that compared each of the three remedies, peppermint oil, fibre, and antispasmodics to either placebo or no treatment. In total, more than 2,500 adult IBS sufferers were involved in the trials.

Peppermint oil has been shown to have antispasmodic properties and has become a popular self-help treatment for IBS. It is also recommended by alternatives therapists. Based on four trials deemed of high enough quality and involving 392 patients it emerged as the most effective of the three treatment options reviewed.

Twelve studies involving 591 patients looked at the effect of fibre on IBS symptoms. The analysis found that soluble fibre such as that found in psyllium (another popular recommendation amongst alternative medicine practitioners) was significantly reduced symptoms, but insoluble fibre such as bran, was not beneficial.

The researchers say that traditionally, IBS patients have been advised to increase their daily intake of dietary fibre because of its potential to improve transit time. The study results now provide evidence that the type of fibre is of high importance.

Finally the researchers looked at 22 studies that compared antispasmodics with placebo in 1,778 patients. Hyoscine was found to be the most successful at preventing symptoms of IBS. The researchers suggested the treatment be used as a first-line antispasmodic therapy.

"The results of this study should reawaken interest in the pharmacotherapy of IBS and stimulate further research," wrote Roger Jones, professor of general practice at King's College, London, in an accompanying editorial.

He added however that successful IBS treatment is multifactorial and therefore psychological, dietary and lifestyle factors need to be addressed.

Eamonn Quigley, MD, President of the American College of Gastroenterology and study contributor, said he would advise antispasmodics for the short-term relief of pain and for bloating and gas. Given the very positive results but limited number of studies conducted he said peppermint oil was worth a try. Finally he said fibre was useful but really only in those with constipation predominant IBS.

Source: British Medical Journal



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