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Therapy options in irritable bowel syndrome

Enck, Paula; Junne, Floriana; Klosterhalfen, Sibyllea,b; Zipfel, Stephana; Martens, Utea

European Journal of Gastroenterology & Hepatology: December 2010 - Volume 22 - Issue 12 - p 1402–1411
doi: 10.1097/MEG.0b013e3283405a17
Review Articles

Background Numerous meta-analyses have recently assessed the overall clinical benefit of single therapy options and groups of therapies in the irritable bowel syndrome (IBS). By large, this should enable physicians to select from a number of therapy options available.

Methods We entered dichotomous outcome data from 121 IBS trials published over the last 35 years with different groups and subgroups of drugs (antispasmodics, motility-affecting agents, antidepressants, peppermint oil), dietary interventions (bran, probiotics), and psychotherapy (cognitive behavioral, psychodynamic, hypnotherapy, relaxation techniques) into meta-analytic tools and estimate the overall efficacy (odds ratio, number needed to treat).

Results Highest efficacy is currently found for peppermint oil, followed by psychotherapeutic and psychopharmacological interventions and probiotics. Traditional antispasmodic therapy has a moderate efficacy, whereas the list of (partially failed or cancelled) motility affecting drugs yielded weak clinical results, and therapies by bran and fibers are of no value in IBS.

Conclusion Evidence-based therapy in IBS provides a number of effective treatment options beyond the fact that many novel compounds under development have failed to reach the market. An algorithm for clinical therapy decision is proposed.

All supplementary material is available directly from the corresponding author.

aDepartment of Internal Medicine VI, University Hospital, Tübingen

bInstitute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany

Correspondence to Prof. Dr Paul Enck, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital, Frondsbergstr. 23, Tübingen 72076, Germany Tel: +49 7071 2989118; fax: +49 7071 294382; e-mail:

Received August 3, 2010

Accepted September 6, 2010

© 2010 Lippincott Williams & Wilkins, Inc.