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Review: smooth muscle relaxants treat abdominal pain and loperamide reduces diarrhoea in irritable bowel syndrome

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 QUESTION: What is the effectiveness of pharmacological agents for the treatment of irritable bowel syndrome (IBS)?

Data sources

Studies were identified by searching Medline (1966–99), EMBASE/Excerpta Medica (1980–99), PsycINFO (1967–99), and the Cochrane Controlled Trials Registry with terms that included colonic diseases, functional, irritable, spastic, bowel, and colon and by manually searching bibliographies of relevant studies.

Study selection

Published studies in the English language were selected if they examined use of a pharmacological treatment for IBS on >10 adult patients for ≥2 weeks; included a placebo group; reported an outcome measure of global status or individual symptoms, or both, of IBS; and used a randomised, double blind, parallel group or crossover design.

Data extraction

Data were extracted on the diagnostic criteria for IBS, participant characteristics, interventions, study design, methodological quality (scored between 1 and 5 with a higher score representing higher quality; studies with a score ≥4 were classified as “high quality”), and outcomes. Pharmacological agents were classified as having “positive” effectiveness if the study reported significant improvement in global status or individual IBS symptoms; otherwise, they were classified as having “negative” effectiveness.

Main results

70 studies (4836 patients, median age …

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  • Source of funding: not stated.

  • For correspondence: Dr T F Imperiale, Health Services Research and Development, Route 11-H, Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA. Fax +1 317 554 0114.