Published 6 January 2009, doi:10.1136/bmj.a3150
Cite this as: BMJ 2009;338:a3150

Letters

Irritable bowel syndrome

Don’t forget amitriptyline

The first 100% of the full text of this article appears below.

As Jones argues,¹ a holistic and integrated approach is necessary for irritable bowel syndrome. Therefore Ford and colleagues² should have mentioned somewhere the potential benefits of amitriptyline. At low doses (10-25 mg at night) some patients, particularly those with diarrhoea predominant irritable bowel syndrome, derive symptomatic benefit. A recent meta-analysis by the same authors has shown a positive effect with a number needed to treat of 4.³

Amitriptyline remains an old but important addition to the clinicians’ armamentarium and is in keeping with a holistic approach for patients with irritable bowel syndrome.⁴

Cite this as: BMJ 2009;338:a3150

¹ Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, ² Belgrave Medical Centre, Sheffield

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Competing interests: None declared.

1. Jones R. Treatment of irritable bowel syndrome in primary care. BMJ 2008;337:a2213. (13 November.)[Free Full Text]
2. Ford AC, Talley NJ, Spiegel BMR, Foxx-Orenstein AE, Schiller L, Quigley EMM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review of the literature and meta-analysis. BMJ 2008;337:a2313. (13 November.)[Abstract/Free Full Text]
3. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut 2008;Nov 10 [Epub ahead of print].
4. National Institute for Health and Clinical Excellence. Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. London: NICE, 2008. www.nice.org.uk/CG061.

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