Research A review of out-moded IBS treatment approaches, including fibre, anti-spasmodics and peppermint oil has concluded they may be some of the best options available to patients.
Irritable bowel syndrome (IBS), which is characterised by abdominal pain, plus diahorrea and/or constipation can cause years of discomfort for sufferers. The cause is unknown, so a holistic approach, including dietary changes and a range of complementary therapies, is often recommended by GPs.
Peppermint oil, fibre and anti-spasmodics have been used as treatments for around 20 years, but fell from favour when new pharmaceutical medicines appeared and a boom in complementary therapies opened the door to many and varied treatments. The fall from favour was compounded by a lack of reliable data backing up their effectiveness.
Dr Alex Ford and colleagues, writing in the BMJ Online, reviewed trials comparing the three treatments with placebos or no treatment in more than 2,500 adults with IBS.
Their analysis of the results found that doctors needed to treat 11 patients with fibre for one to be effective, five patients with antispasmodics for one to find relief and 2.5 for one IBS sufferer to ease their discomfort. None of the treatments had serious adverse effects.
The researchers analysed 12 studies which compared fibre with placebo or no treatment involving 591 patients. However, insoluble fibre such as bran was not beneficial, only isphaghula husk, which is a soluble fibre, significantly reduced symptoms.
They identified 22 studies comparing various antispasmodics with placebo in 1,778 patients. Hyoscine - extracted from the cork wood tree - was the most successful at preventing symptoms of IBS.
However, the most effective treatment of the three appeared to be peppermint oil, based on four trials involving 392 patients.
These treatments have been overlooked because of the introduction of newer more expensive drugs which were withdrawn due to lack of efficacy and safety concerns, say the authors. All three treatments have been shown to be potentially effective therapies for IBS and current national and international guidelines need to be revised to include this new evidence, they add.
However, Professor Roger Jones, from King's College London, cautions that this new evidence must not detract from the need to make a holistic diagnosis and integrated approach to the treatment of IBS which takes account of the physical, psychological, and social factors involved.