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Systematic review: the efficacy of treatments for irritable bowel syndrome – a European perspective
Author(s) -
TACK J.,
FRIED M.,
HOUGHTON L. A.,
SPICAK J.,
FISHER G.
Publication year - 2006
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2006.02938.x
Subject(s) - tegaserod , medicine , irritable bowel syndrome , tolerability , bloating , constipation , abdominal pain , placebo , clinical trial , adverse effect , alternative medicine , pathology
Summary Background Irritable bowel syndrome (IBS) is a common, chronic disorder, characterized by abdominal pain/discomfort, bloating and altered bowel habit. Aim To conduct a systematic evidence‐based review of pharmacological therapies currently used, or in clinical development, for the treatment of IBS in Europe. The safety and tolerability of these therapies are the subject of an accompanying review. Methods A literature search was completed for randomized controlled studies which included adult patients with IBS and an active or placebo control, assessed IBS symptoms, and were published in English between January 1980 and June 2005. The level of evidence for efficacy was graded according to the quality of the trial design and the study outcome. Results There is some evidence for improvement of individual IBS symptoms with antidiarrhoeals (diarrhoea), antispasmodics (abdominal pain/discomfort), bulking agents (constipation), tricyclic antidepressants (abdominal pain/discomfort) and behavioural therapy. In contrast, there is strong evidence for the improvement of global IBS symptoms with two new serotonergic agents: the 5‐HT 4 selective agonist tegaserod (IBS with constipation) and the 5‐HT 3 antagonist alosetron (IBS with diarrhoea). Further data are required for the 5‐HT 3 antagonist, cilansetron, and the mixed 5‐HT 3 antagonist/5‐HT 4 agonist renzapride before their utility in IBS can be appraised. Conclusions There is limited evidence for the efficacy, safety and tolerability of therapies currently available in Europe for the treatment of IBS. Overall, there is an absence of pharmacological agents licensed specifically for the treatment of IBS subtypes, and new agents are awaited in Europe that will allow changes in clinical practice to focus on and improve global IBS symptoms.