http://annals.org/ en-us Tue, 20 Dec 2011 00:00:00 GMT Tue, 09 Apr 2013 13:47:24 GMT Silverchair editor@annals.org webmaster@annals.org http://annals.org/article.aspx?articleID=1033249 Tue, 20 Dec 2011 00:00:00 GMT Baicus C, Voiosu T. <span class="paragraphSection"><div class="boxTitle">Question</div>What is the efficacy of antispasmodic drugs, antidepressant drugs, and bulking agents for the irritable bowel syndrome (IBS)?<div class="boxTitle">Review scope</div>Included studies compared antispasmodic drugs, antidepressant drugs, or bulking agents with placebo in patients > 12 years of age who had IBS diagnosed clinically or using predefined diagnostic criteria. Studies of functional bowel disorders were included if > 75% of patients had IBS; the first period of crossover studies was included. Outcomes were improvement in abdominal pain, overall global assessment, and IBS symptom scores.<div class="boxTitle">Review methods</div>MEDLINE, EMBASE/Excerpta Medica, Cochrane Library, CINAHL, PsycINFO (all to Mar 2009), and reference lists were searched for fully published randomized controlled trials (RCTs) with extractable data. Authors were contacted if essential data were missing. 56 RCTs (<span style="font-style:italic;">n</span> = 3725) met the selection criteria: 29 (<span style="font-style:italic;">n</span> = 2333, mean age 26 to 61 y, 35% to 100% women) evaluated antispasmodics; 15 (<span style="font-style:italic;">n</span> = 922, mean age 32 to 49 y, 13% to 100% women) antidepressants; and 12 (<span style="font-style:italic;">n</span> = 621, mean age 28 to 46 y, 20% to 83% women) bulking agents. 10 RCTs had low risk for bias for randomization methods, 15 for allocation concealment, 26 for blinding, 46 for follow-up, and 52 for selective reporting.<div class="boxTitle">Main results</div>Meta-analysis showed that antispasmodic and antidepressant drugs were each better than placebo for improving abdominal pain, symptom scores, and global assessment (Table); bulking agents and placebo did not differ for any outcome (Table).<div class="boxTitle">Conclusion</div>Antispasmodic and antidepressant drugs were each more effective than placebo for the irritable bowel syndrome; bulking agents did not differ from placebo.<div class="boxTitle">Antispasmodic drugs, antidepressant drugs, or bulking agents vs placebo in patients with the irritable bowel syndrome*</div>Treatment typeOutcomesNumber of trials (<span style="font-style:italic;">n</span>)Weighted event ratesRBI (95% CI)NNT (CI)Antispasmodic drugsImproved abdominal pain13 (1392)62% vs 46%32% (12 to 55)7 (4 to 17)Improved global assessment22 (1983)60% vs 39%49% (25 to 77)5 (4 to 8)Improved symptom score4 (586)63% vs 30%86% (26 to 176)4 (2 to 25)Antidepressant drugsImproved abdominal pain8 (517)59% vs 37%49% (5 to 112)5 (3 to 17)Improved global assessment11 (750)61% vs 35%57% (23 to 100)4 (3 to 7)Improved symptom score3 (159)53% vs 26%99% (32 to 199)†4 (3 to 9)Bulking agentsImproved global assessment11 (565)60% vs 49%10% (−9 to 33)Not significantStandardized mean difference (CI)‡Bulking agentsImproved abdominal pain2 (116)§0.03 (−0.34 to 0.40)Improved symptom score2 (84)§0.00 (−0.43 to 0.43)†*Abbreviations defined in <a href="/shared/glossary.htm">Glossary</a>. Weighted event rates, RBI, NNT, and CI calculated from control event rates and risk ratios reported in article using a random-effects model unless stated otherwise.†Fixed-effect model.‡Positive standardized mean difference = greater improvement for bulking agents.§2 of 4 (abdominal pain) or 3 (symptom score) eligible studies provided sufficient data for meta-analysis.</span> http://annals.org/article.aspx?articleID=1033249