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Review
. 2008 Nov 13:337:a2313.
doi: 10.1136/bmj.a2313.

Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis

Alexander C Ford  1 , Nicholas J Talley, Brennan M R Spiegel, Amy E Foxx-Orenstein, Lawrence Schiller, Eamonn M M Quigley, Paul Moayyedi
Affiliations
Review

Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis

Alexander C Ford et al. BMJ. .

Erratum in

  • BMJ.2009;338:b1881

Abstract

Objective: To determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Medline, Embase, and the Cochrane controlled trials register up to April 2008. Review methods Randomised controlled trials comparing fibre, antispasmodics, and peppermint oil with placebo or no treatment in adults with irritable bowel syndrome were eligible for inclusion. The minimum duration of therapy considered was one week, and studies had to report either a global assessment of cure or improvement in symptoms, or cure of or improvement in abdominal pain, after treatment. A random effects model was used to pool data on symptoms, and the effect of therapy compared with placebo or no treatment was reported as the relative risk (95% confidence interval) of symptoms persisting.

Results: 12 studies compared fibre with placebo or no treatment in 591 patients (relative risk of persistent symptoms 0.87, 95% confidence interval 0.76 to 1.00). This effect was limited to ispaghula (0.78, 0.63 to 0.96). Twenty two trials compared antispasmodics with placebo in 1778 patients (0.68, 0.57 to 0.81). Various antispasmodics were studied, but otilonium (four trials, 435 patients, relative risk of persistent symptoms 0.55, 0.31 to 0.97) and hyoscine (three trials, 426 patients, 0.63, 0.51 to 0.78) showed consistent evidence of efficacy. Four trials compared peppermint oil with placebo in 392 patients (0.43, 0.32 to 0.59).

Conclusion: Fibre, antispasmodics, and peppermint oil were all more effective than placebo in the treatment of irritable bowel syndrome.

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Conflict of interest statement

Competing interests: NJT has received consultancy fees from Procter and Gamble, Lexicon Genetics, Astellas Pharma US, Pharma Frontiers, Callisto Pharmaceuticals, AstraZeneca, Addex Pharma, Ferring Pharma, Salix, MGI Pharma, McNeil Consumer, Microbia, Dynogen, Conexus, Novartis, and Metabolic Pharmaceuticals, and has received research support from Novartis, Takeda, GlaxoSmithKline, Dynogen, and Tioga. EMMQ has received consultant’s and speaker’s bureau fees from Nycomed, Boehringer Ingelheim, Procter and Gamble, Reckitt Benckiser, and Prometheus, and holds equity in Alimentary Health. PM holds a chair at McMaster University partly funded by an unrestricted donation by AstraZeneca, and has received consultant’s and speaker’s bureau fees from AstraZeneca, AxCan Pharma, Nycomed, and Johnson and Johnson.

Figures

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Fig 1 Flow diagram of studies in systematic review
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Fig 2 Forest plot of randomised controlled trials of fibre versus placebo or low fibre diet in irritable bowel syndrome. Events are number of patients with either global symptoms of irritable bowel syndrome or abdominal pain unimproved or persistent after treatment
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Fig 3 Forest plot of randomised controlled trials of antispasmodics versus placebo in treatment of irritable bowel syndrome. Events are number of patients with either global symptoms of irritable bowel syndrome or abdominal pain unimproved or persistent after treatment. See bmj.com for individual tests for heterogeneity and for overall effect
None
Fig 4 Forest plot of randomised controlled trials of peppermint oil versus placebo in irritable bowel syndrome. Events are number of patients with either global symptoms of irritable bowel syndrome or abdominal pain unimproved or persistent after treatment
See this image and copyright information in PMC

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