WebMD Health News
Louise Chang, MD
Nov. 13, 2008 -- Largely overlooked, older remedies like peppermint oil and fiber are effective treatments for irritable bowel syndrome (IBS), a review of the research shows.
The analysis shows that these remedies and some antispasmodic drugs that are no longer widely prescribed work well, researcher Alexander C. Ford, MD, tells WebMD.
Newer drugs that once held great promise for the treatment of the poorly understood bowel disorder have largely proven disappointing, either because serious side effects emerged or they were not very effective.
So there is currently no clear first-line treatment for patients with irritable bowel syndrome, Ford says.
"Most of the treatments we examined have fallen out of clinical favor," he says. "But they work, they are cheap, and they're far less toxic than some of the newer drugs."
Surveys suggest that anywhere from 5% to 20% of people suffer from irritable bowel syndrome, a disorder with a wide range of symptoms that may include crampy abdominal pain, gas, diarrhea, and/or constipation.
In February 2000, Lotronex became the first drug approved in the U.S. specifically to treat IBS, but it was withdrawn from the market later that year because of potentially life-threatening gastrointestinal side effects.
The drug was later reintroduced, but its use is now restricted to women with severe diarrhea-predominant IBS who have failed other treatments.
In March 2007, another IBS drug, Zelnorm, was also withdrawn from the market by its maker, Novartis, at the request of the FDA because of an increased risk for heart attack and stroke.
"These new-generation drugs were going to be the magic bullets for IBS, but it didn't turn out that way," King's College London professor of general practice Roger Jones, DM, FRCP, tells WebMD. "I think this new paper is important because it shows patients and their physicians that these older treatments can be effective."
Ford and colleagues combined the results from 12 studies comparing fiber with placebo or no treatment, 22 studies comparing different antispasmodic drugs to placebo, and four studies examining treatment with peppermint oil.
Although there were fewer peppermint oil studies, the trials were well designed and all showed peppermint oil to be effective.
Other highlights of the analysis include:
Ford and colleagues concluded that psyllium-fiber therapy is a good first-line treatment for constipation-predominant IBS, while peppermint oil and scopolamine are good choices for diarrhea-predominant IBS.
The analysis appears in the latest issue of BMJ Online First. In an accompanying editorial, Jones writes that the findings should reawaken interest in these treatments and spur research into their use for IBS.
"We really don't know which patients benefit most from which type of treatment," he tells WebMD.
SOURCES: Ford, A.C. BMJ Online First.Alexander C. Ford, MD, gastroenterology division, McMaster University,
Ontario, Canada.Roger J. Jones, DM, FRCP, professor, department of general practice and
primary care, King's College, London.
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