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

We considered both short term relief of symptoms, during periods of exacerbation of symptoms, and sustained, longer term effectiveness to be relevant in evaluating the effectiveness of fibre treatment

C J Bijkerk; N J de Wit; J W M Muris; P J Whorwell; J A Knottnerus; A W Hoes

2009

Scholarcy highlights

  • Irritable bowel syndrome is a common functional gastrointestinal disorder characterised by recurrent episodes of abdominal pain or discomfort associated with an altered bowel habit, not explained by any structural or biochemical changes in the gut. The prevalence of irritable bowel syndrome in the population is in the order of 10%, and approximately a quarter of people with irritable bowel syndrome symptoms seek medical advice.2Most studies report a female predominance, and the reported incidence of irritable bowel syndrome in primary care is 4-13 per 1000 patients per year, less than 5% of whom are referred to hospital. Irritable bowel syndrome is a chronic recurrent condition with relapsing symptoms in more than half of patients. It should not be diagnosed by exclusion but rather as a “positive” diagnosis
  • The proportion of responders was significantly greater in the psyllium group than in the placebo group during the first month and the second month of treatment
  • After three months of treatment, symptom severity in the psyllium group was reduced by 90 points, compared with 49 points in the placebo group and 58 points in the bran group
  • Fifty four of the patients allocated to psyllium, 54 in the bran group, and 56 in the placebo group completed the three month treatment period
  • Dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened
  • We found no significant differences between the three groups with respect to changes in the severity of abdominal pain related to irritable bowel syndrome or in quality of life
  • Patients aged between 18 and 65 years who had been diagnosed as having irritable bowel syndrome in the previous two years were selected from the medical electronic files of the participating practices by using the international classification of health problems in primary care code D93 or the text words “IBS” or “spastic colon.” The selected patients received an invitation signed by their general practitioner to participate in the trial
  • Psyllium offers benefits in patients with irritable bowel syndrome in primary care

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