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Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3154 (Published 27 August 2009) Cite this as: BMJ 2009;339:b3154

Psyllium, stool thickness and potential for bezoar formation.

I have prescribed psyllium on many occasions, exclusively for
decreasing the liquidity in stool and optimizing sphincteric control after
closing the defunctioning ileostomy following a total abdominal colectomy
and ileo-anal anastomosis performed for ulcerative colitis. Taken in
larger amounts it usually acts as a cathartic but has the potential to
cause obstruction by removing fluid from stool and promoting the formation
of a bezoar(1). There are several reversible causes of symptoms
attributable to the "irritable bowel syndrome", including chronic
mesenteric ischaemia(2), and these should be excluded and reversed if
found before resorting to extended empirical therapy including the
administration of supposedly soluable psyllium and/or insoluable bran.

1. Farooq P. Agha, Timothy T. Nostrant, Richard G. Fiddian-Green.
"Giant Colonic Bezoar": A Medication Bezoar Due to Psyllium Seed Husks.
The American Journal of Gastroenterology. Volume 79 Issue 4, Pages 319 -
321

2. Michel Lièvre. Alosetron for irritable bowel syndrome
BMJ 2002; 325: 555-556 [See rapid responses].

Competing interests:
None declared

Competing interests: No competing interests

11 September 2009
Richard G Fiddian-Green
FRCS, FACS
None