An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome
Abstract
Section 2.1 Methodology for systematic reviews of irritable bowel syndrome therapy, levels of evidence, and grading of recommendations We have conducted a series of systematic reviews on the diagnostic criteria, the value of diagnostic tests, and the efficacy of therapy in IBS. We also performed a narrative review of the epidemiology of IBS. There have been several systematic reviews of therapy for IBS (1-5), but these either have not quantitatively combined the data into meta-analyses (1-3) or have inaccuracies in applying eligibility criteria and data extraction (4,5). We have, therefore, repeated all systematic reviews of IBS and synthesized the data where appropriate. Systematic review methodology For all reviews, we evaluated manuscripts that studied adults using any definition of IBS. This included a clinician-defined diagnosis, Manning criteria (6), the Kruis score (7), or Rome I (8), II (9), or III (10) criteria. For reviews of diagnostic tests, we included case series and case-control studies that evaluated serologic tests for celiac sprue (anti-gliadin, anti-endomysial, and tissue transglutaminase antibodies), lactose hydrogen breath tests, and tests for small bowel bacterial overgrowth (lactulose and glucose hydrogen breath test or jejunal aspirates). For reviews of therapies of IBS, we included only parallel group RCTs comparing active intervention with either placebo or no therapy. The following treatments were considered: Diet Fiber, bulking agents, and laxatives Antispasmodics and Peppermint Oil Antidiarrheal agents Antibiotic therapy Probiotic therapy 5HT3 antagonists 5HT4 agonists Selective C-2 chloride channel activators (Lubiprostone) Antidepressants Psychological therapies Herbal therapies and acupuncture Emerging therapies Subjects needed to be followed up for at least one week. The trial needed to include one or more of the following outcome measures: Global assessment of IBS cure or improvement Abdominal pain cure or improvement Global IBS symptom or abdominal pain scores Search strategy for identification of studies Medline (1966-June 2008), Embase (1988-June 2008), and the Cochrane Controlled Trials Register (Issue 2, 2008) electronic databases were searched. An example of the Medline search is given below. IBS patients were identified with the terms irritable bowel syndrome and functional diseases, colon (both as medical subject heading (MeSH) and free text terms), and IBS, spastic colon, irritable colon, and functional adj5 (adj5 is a term used by Medline for words that appear within 5 adjectives of each other) bowel (as free text terms). Studies identified from this search were combined with the following terms used to identify therapies for IBS: dietary fiber, cereals, psyllium, sterculia, karaya gum, parasympatholytics, scopolamine, trimebutine, muscarinic antagonists, and the following free text terms: bulking agent, psyllium fiber, fiber, husk, bran, ispaghula, wheat bran, spasmolytics, spasmolytic agents, antispasmodics, mebeverine, alverine, pinaverium bromide, otilonium bromide, cimetropium bromide, hyoscine butyl bromide, butylscopolamine, peppermint oil, loperamide and colpermin, serotonin antagonists, serotonin agonists, cisapride, receptors (serotonin, 5-HT3), and receptors (serotonin, 5-HT4; both as MeSH terms and free text terms), and the following free text terms: 5-HT3, 5-HT4, alosetron, cilansetron, tegaserod, and renzapride, psychotropic drugs, antidepressive agents, antidepressive agents (tricyclic), desipramine, imipramine, trimipramine, doxepin, dothiepin, nortriptyline, amitriptyline, selective serotonin re-uptake inhibitors, paroxetine, sertraline, fluoxetine, citalopram, venlafaxine, cognitive therapy, psychotherapy, behaviour therapy, relaxation techniques, and hypnosis (both as MeSH terms and free text terms), and the following free text terms: behavioral therapy, relaxation therapy, and hypnotherapy. Saccharomyces, Lactobacillus, Bifidobacterium, Escherichia coli or probiotics (MeSH and free text terms). An RCT filter was applied to the electronic searches. The searches were limited to humans. A recursive search of the bibliography of relevant articles also was conducted. DDW abstract books were hand searched between 2000 and 2008; UEGW abstract books were hand searched between 2000 and 2007. Authors of trial reports that did not give enough detail for adequate data extraction were contacted and asked to contribute full datasets. Experts in the field were contacted for leads on unpublished studies and no language restrictions were applied. Trials were assessed for risk of bias according to three characteristics: method of randomization, method of concealment of treatment allocation, and implementation of masking. In addition the of studies were according to the with a score of a and outcome data were by the and by a on was by using a were as and were to be treatment any improvement of IBS as a outcome was as the outcome this was not improvement in abdomi
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Treatments targeting the CNS, such as antidepressants and psychological interventions, can reduce intestinal sensation/sensitivity and improve GI symptoms in patients with IBS.
“Furthermore, treatments targeting the CNS, such as antidepressants and psychological interventions, can reduce intestinal sensation/sensitivity and improve GI symptoms in patients with IBS (21, 111, 150, 165).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [21]
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Manning Criteria in Irritable Bowel Syndrome: Its Diagnostic Significance
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Calcium polycarbophil compared with placebo in irritable bowel syndrome
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The Symptomatic Effect of Cisapride in Patients with Irritable Bowel Syndrome and Constipation
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Randomised-controlled trial of a fibre supplement on the symptoms of irritable bowel syndrome
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Different Autonomic Responses to Experimental Pain in IBS Patients and Healthy Controls
Tousignant‐Laflamme, Y., Goffaux, P., Bourgault, P., & Marchand, S. (2006) · Journal of Clinical Gastroenterology · doi:10.1097/01.mcg.0000225607.56352.ce · Cited by 47 · see citing works
Breath Tests for Gastrointestinal Disease: The Real Deal or Just a Lot of Hot Air?
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Self-citationVisceral hypersensitivity and intolerance symptoms in lactose malabsorption
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Managing functional bowel disorders from the top down: lessons from a well-designed treatment trial
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Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation
Pimentel, M., Lembo, A., Chey, W. D., Zakko, S., Ringel, Y., Yu, J., Mareya, S. M., Shaw, A. L., Bortey, E., & Forbes, W. P. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1004409 · Cited by 1,036 · see citing works
Self-citationPlacebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome
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“[11,13] Previous research has demonstrated that placebo responses in IBS are substantial and clinically significant.”
BackgroundFord, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.202 · Cited by 747 · see citing works
Self-citationFord, A. C., Harris, L. A., Lacy, B. E., Quigley, E. M. M., & Moayyedi, P. (2018) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15001 · Cited by 619 · see citing works
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Self-citationFord, A. C., Quigley, E. M. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E. E., Spiegel, B. M. R., & Moayyedi, P. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.148 · Cited by 405 · see citing works
Self-citationGuandalini, S., Magazzù, G., Chiaro, A., La Balestra, V., Di Nardo, G., Gopalan, S., Sibal, A., Romano, C., Canani, R. B., Lionetti, P., et al. (2010) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e3181ca4d95 · Cited by 273 · see citing works
Ford, A. C., Brandt, L. J., Young, C., Chey, W. D., Foxx-Orenstein, A. E., & Moayyedi, P. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.223 · Cited by 261 · see citing works
Self-citationJohnston, J. M., Kurtz, C. B., MacDougall, J. E., Lavins, B. J., Currie, M. G., Fitch, D. A., O'Dea, C., Baird, M., & Lembo, A. J. (2010) · Gastroenterology · doi:10.1053/j.gastro.2010.08.041 · Cited by 229 · see citing works
Anxiety Is Linked to New-Onset Dyspepsia in the Swedish Population: A 10-Year Follow-up Study
Aro, P., Talley, N. J., Johansson, S.-E., Agréus, L., & Ronkainen, J. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.01.039 · Cited by 162 · see citing works
Self-citationIntestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome
Ringel, Y., & Maharshak, N. (2013) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00207.2012 · Cited by 115 · see citing works
Huang, H. L., Chen, H. T., Luo, Q. L., Xu, H. M., He, J., Li, Y. Q., Zhou, Y. L., Yao, F., Nie, Y. Q., & Zhou, Y. J. (2019) · Journal of Digestive Diseases · doi:10.1111/1751-2980.12756 · Cited by 89 · see citing works
Spiegel, B. M. R. (2011) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2011.02.030 · Cited by 67 · see citing works
Self-citationIntervening on cognitions and behavior in irritable bowel syndrome: A feasibility trial using PDAs
Oerlemans, S., van Cranenburgh, O., Herremans, P.-J., Spreeuwenberg, P., & van Dulmen, S. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.09.018 · Cited by 67 · see citing works
Grover, M., & Camilleri, M. (2013) · Journal of Gastroenterology · doi:10.1007/s00535-012-0726-5 · Cited by 65 · see citing works
- Authors
- Brandt, L. J., Chey, W. D., Foxx-Orenstein, A. E., Quigley, E. M. M., Schiller, L. R., Schoenfeld, P. S., Spiegel, B. M., Talley, N. J., & Moayyedi, P.
- Affiliations
- Montefiore Medical Center (US)
- Michigan Medicine (US)
- Cork University Hospital (IE)
- Baylor University Medical Center (US)
- VA Ann Arbor Healthcare System (US)
- University of California, Los Angeles (US)
- Mayo Clinic (US)
- McMaster University Medical Centre (CA)
- Corresponding author
- Brandt, Lawrence J.
- ORCID
- Venue
- American Journal of Gastroenterology
- Published
- 2009-01
- Volume
- 104
- Pages
- S8-S35
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W2978149037
- Semantic Scholar
- 0791e96d7a99add0b68d1353721c81d948b6c595
- Cited by
- 225
- References
- 218
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 8 · 2021: 3 · 2020: 13 · 2019: 6 · 2018: 10 · 2017: 65 · 2016: 9 · 2015: 10 · 2014: 13 · 2013: 12 · 2012: 20
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- irritable bowel syndrome, IBS management, dietary fiber, bulking agents, laxatives, antispasmodic agents, peppermint oil, probiotics, 5-HT3 receptor antagonists, 5-HT4 receptor agonist, lubiprostone, antidepressants, psychotherapy, herbal medicine, acupuncture, small intestinal bacterial overgrowth, lactose intolerance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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