Advertisement

Fiber, Antispasmodic Agents, and Peppermint Oil for Irritable Bowel Syndrome

Summary and Comment |
December 4, 2008

Fiber, Antispasmodic Agents, and Peppermint Oil for Irritable Bowel Syndrome

  1. Paul S. Mueller, MD, MPH, FACP

All these agents were more effective than placebo for patients with IBS.

  1. Paul S. Mueller, MD, MPH, FACP

Irritable bowel syndrome (IBS), which affects 5% to 20% of the population, is a chronic gastrointestinal disorder characterized by relapsing and remitting bouts of abdominal pain and altered bowel movements. Evidence suggests that fiber, antispasmodic agents, and peppermint oil all are effective for treating patients with IBS. In this systematic review and meta-analysis, investigators evaluated the efficacy of these agents.

In 12 randomized controlled trials (591 patients), fiber was compared with placebo or no treatment; in 22 trials (1778 patients), antispasmodic agents were compared with placebo; and in 4 trials (392 patients), peppermint oil was compared with placebo. Persistent IBS symptoms were significantly less common in patients treated with fiber (relative risk, 0.87), antispasmodic agents (RR, 0.68), and peppermint oil (RR, 0.43) than with placebo. The number of patients needed to treat to prevent 1 patient from experiencing persistent IBS symptoms was 11 for fiber, 5 for antispasmodic agents, and 2.5 for peppermint oil.

Comment

Fiber, antispasmodic agents, and peppermint oil are more effective than placebo for alleviating IBS. Among the fiber preparations, benefit was limited to ispaghula husk (psyllium; Metamucil). Among the antispasmodic agents, only otilonium and hyoscine showed consistent benefit. (Otilonium is unavailable in the U.S.) Hyoscine (scopolamine), a belladonna alkaloid, is available in pill and patch forms. Notably, a similar drug, hyoscyamine (Levsin), is commonly used to treat IBS. Peppermint oil appears to be a promising treatment and is available over the counter; in the trials, doses of peppermint oil ranged from 187 mg to 225 mg, and it was given two to four times daily. These new data are welcome, especially because prescription IBS drugs (e.g., Zelnorm) have been withdrawn from the market recently.

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement