Published 13 November 2008, doi:10.1136/bmj.a2313
Cite this as: BMJ 2008;337:a2313

Research

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

¹ Gastroenterology Division, McMaster University, Health Sciences Centre, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada, ² Department of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA, ³ VA Greater Los Angeles Healthcare System; UCLA/VA Center for Outcomes Research and Education, Los Angeles, CA, USA, ⁴ Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA, ⁵ Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, TX, USA, ⁶ Department of Medicine, Cork University Hospital, Ireland

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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