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Soluble or insoluble fibre in irritable bowel syndrome in primary care?





BMJ. 2009 Aug 27;339:b3154. doi: 10.1136/bmj.b3154.


Soluble or insoluble fibre in irritable bowel syndrome in primary care?


Randomised placebo controlled trial.Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. This email address is being protected from spambots. You need JavaScript enabled to view it.



OBJECTIVE: To determine the effectiveness of increasing the dietary content of soluble fibre (psyllium) or insoluble fibre (bran) in patients with irritable bowel syndrome. DESIGN: Randomised controlled trial.


SETTING: General practice.


PARTICIPANTS: 275 patients aged 18-65 years with irritable bowel syndrome.


NTERVENTIONS: 12 weeks of treatment with 10 g psyllium (n=85), 10 g bran (n=97), or 10 g placebo (rice flour) (n=93).


MAIN OUTCOME MEASURES: The primary end point was adequate symptom relief during at least two weeks in the previous month, analysed after one, two, and three months of treatment to assess both short term and sustained effectiveness. Secondary end points included irritable bowel syndrome symptom severity score, severity of abdominal pain, and irritable bowel syndrome quality of life scale.


RESULTS: The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month (57% v 35%; relative risk 1.60, 95% confidence interval 1.13 to 2.26) and the second month of treatment (59% v 41%; 1.44, 1.02 to 2.06). Bran was more effective than placebo during the third month of treatment only (57% v 32%; 1.70, 1.12 to 2.57), but this was not statistically significant in the worst case analysis (1.45, 0.97 to 2.16). After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group (P=0.03) and 58 points in the bran group (P=0.61 versus placebo). No differences were found with respect to quality of life. Fifty four (64%) of the patients allocated to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group completed the three month treatment period. Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened.


CONCLUSIONS: Psyllium offers benefits in patients with irritable bowel syndrome in primary care.


TRIAL REGISTRATION: Clinical trials NCT00189033.


PMID: 19713235 [PubMed - in process]










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  • Here we have a randomised controlled trial (RCT), the gold standard of medical research published in the British Medical Journal clearly indicating psyllium (soluble fibre available as a supplement) significantly reduces symptoms compared to placebo (and bran) and acts quickly. I would question whether rice flour was an appropriate placebo because it has potential to modify the gut microflora - changes in which are suspected to be involved in IBS.

    I would also caution against using psyllium if you have high stress levels and chronically tense intestinal muscles as a result. My personal experience is that psyllium/faecal matter can get stuck and cause obstruction in the colon under these circumstances. Always drink plenty of water when using psyllium supplements and don't take more than advised.

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