Evidence-based Treatment for an Irritable Bowel Syndrome Patient_Chinese Journal of Evidence-Based Medicine

Authors：

YAN Xia ,  DING Yijuan

Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China;

Corresponding author：

DING Yijuan, Email: dingyijuan@tom.com

Keywords：

Irritable bowel syndrome; Evidence-based treatment; Randomized controlled trial; Systematic reviews

DOI：

10.7507/1672-2531.20090179

Video：

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Objective 　To make an individualized treatment plan for newly diagnosed irritable bowel syndrome by means of evidence-based medicine.
Methods 　After clinical problems were put forward, systematic reviews and randomized controlled trials were collected from The Cochrane Library (Issue 3, 2008) and PubMed (1990 to 2008). Treatment protocol was produced by combining the evidence and the values of the patient.
Results 　A total of 114 RCTs and 21 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data to control symptoms and improve the quality of life for the patient. After a sixteen-month follow-up, the plan proved to be optimal.
Conclusion 　The treatment efficacy in diagnosed irritable bowel syndrome has been improved by determining an individualized treatment plan according to evidence-based methods.

Citation： YAN Xia,DING Yijuan. Evidence-based Treatment for an Irritable Bowel Syndrome Patient. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 1018-1021. doi: 10.7507/1672-2531.20090179 Copy

1.	Ford AC, Talley NJ, Spiegel BM. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ, 2009, 14(3):84.
2.	Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn, 2006, 54(1): 7-20.
3.	Klooker TK, Kuiken SD, Lei A. Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4): 605-615.
4.	Vahedi H, Merat S, Rashidioon A. The effect of fluoxetine in patients with pain and consti 2007 M pation-predominant irritable bowel syndrome: a double-blind randomized-controlled study. Aliment Pharmacol Ther, 2005, 22(5): 381-385.
5.	Vahedi H, Merat S, Momtahen S. Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2008, 27(8): 678-684.
6.	Kajander K, Myllyluoma E. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
7.	Jones BW, Moore DJ, Robinson SM, et al. A systematic review of tegaserod for the treatment of irritable bowel syndrome. J Clin Pharm Ther, 2002, 27(5): 343-352.
8.	Drouault-Holowacz S, Bieuvelet S. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
9.	Moayyedi P, Ford AC, Talley NJ. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review. Gut, 2008, 30(5): 123-126.
10.	McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol, 2008, 14(17): 2650-2661.
11.	Pimentel M, Chatterjee S, Chow EJ, et al. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
12.	van Kerkhoven LA, Laheij RJ, Aparicio N. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
13.	Lee V, Guthrie E, Robinson A. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. J Psychosom Res, 2008, 64(2): 129-138.
14.	Bijkerk CJ, Muris JW, Knottnerus JA, et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2004, 19(3): 245-251.
15.	Huertas-Ceballos A, Logan S, Bennett C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2009, (1): CD003019.
16.	Huertas-Ceballos A, Logan S, Bennett C. Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2008, (1): CD003014.
17.	Rask CU, Thomsen PH. Cognitive behavioural therapy of functional recurrent abdominal pain in children. Ugeskr Laeger, 2007, 169(45): 3839-3845.
18.	Kennedy TM, Chalder T, McCrone P, et al. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial. Health Technol Assess, 2006, 10(19): 1-67.
19.	Lackner JM, Jaccard J, Krasner SS. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology, 2007, 133(2): 433-444.
20.	Kennedy TM, Chalder T, McCrone P. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Health Technol Assess, 2006, 10(19): 1-67.
21.	Talley NJ, Kellow JE, Boyce P. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci, 2008, 53(1): 108-115.
22.	van Kerkhoven LA, Laheij RJ, Aparicio N, et al. Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
23.	Bahar RJ, Collins BS, Steinmetz B. Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents. J Pediatr, 2008, 152(5): 685-689.
24.	Creed F, Tomenson B, Guthrie E. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res, 2008, 64(6): 613-620.
25.	Pimentel M, Chat ter jee S, Chow EJ . Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
26.	Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
27.	Fennerty MB. Traditional therapies for irritable bowel syndrome: an evidence-based appraisal. Rev Gastroenterol Disord, 2003, 3(Suppl 2): S18-24.
28.	Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc, 2009, 72(6): 294-300.
29.	Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med, 2003, 163(3): 265-274.

1. Ford AC, Talley NJ, Spiegel BM. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ, 2009, 14(3):84.
2. Whitehead WE. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Int J Clin Exp Hypn, 2006, 54(1): 7-20.
3. Klooker TK, Kuiken SD, Lei A. Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4): 605-615.
4. Vahedi H, Merat S, Rashidioon A. The effect of fluoxetine in patients with pain and consti 2007 M pation-predominant irritable bowel syndrome: a double-blind randomized-controlled study. Aliment Pharmacol Ther, 2005, 22(5): 381-385.
5. Vahedi H, Merat S, Momtahen S. Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther, 2008, 27(8): 678-684.
6. Kajander K, Myllyluoma E. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of irritable bowel syndrome and stabilizes intestinal microbiota. Aliment Pharmacol Ther, 2008, 27(1): 48-57.
7. Jones BW, Moore DJ, Robinson SM, et al. A systematic review of tegaserod for the treatment of irritable bowel syndrome. J Clin Pharm Ther, 2002, 27(5): 343-352.
8. Drouault-Holowacz S, Bieuvelet S. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
9. Moayyedi P, Ford AC, Talley NJ. The efficacy of probiotics in the therapy of irritable bowel syndrome: a systematic review. Gut, 2008, 30(5): 123-126.
10. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol, 2008, 14(17): 2650-2661.
11. Pimentel M, Chatterjee S, Chow EJ, et al. Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
12. van Kerkhoven LA, Laheij RJ, Aparicio N. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
13. Lee V, Guthrie E, Robinson A. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation. J Psychosom Res, 2008, 64(2): 129-138.
14. Bijkerk CJ, Muris JW, Knottnerus JA, et al. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2004, 19(3): 245-251.
15. Huertas-Ceballos A, Logan S, Bennett C. Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2009, (1): CD003019.
16. Huertas-Ceballos A, Logan S, Bennett C. Psychosocial interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev, 2008, (1): CD003014.
17. Rask CU, Thomsen PH. Cognitive behavioural therapy of functional recurrent abdominal pain in children. Ugeskr Laeger, 2007, 169(45): 3839-3845.
18. Kennedy TM, Chalder T, McCrone P, et al. Cognitive behavioural therapy in addition to antispasmodic therapy for irritable bowel syndrome in primary care: randomised controlled trial. Health Technol Assess, 2006, 10(19): 1-67.
19. Lackner JM, Jaccard J, Krasner SS. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology, 2007, 133(2): 433-444.
20. Kennedy TM, Chalder T, McCrone P. Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. Health Technol Assess, 2006, 10(19): 1-67.
21. Talley NJ, Kellow JE, Boyce P. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci, 2008, 53(1): 108-115.
22. van Kerkhoven LA, Laheij RJ, Aparicio N, et al. Effect of the antidepressant venlafaxine in functional dyspepsia: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepato, 2008, 6(7): 746-752.
23. Bahar RJ, Collins BS, Steinmetz B. Double-blind placebo-controlled trial of amitriptyline for the treatment of irritable bowel syndrome in adolescents. J Pediatr, 2008, 152(5): 685-689.
24. Creed F, Tomenson B, Guthrie E. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res, 2008, 64(6): 613-620.
25. Pimentel M, Chat ter jee S, Chow EJ . Neomycin improves constipation-predominant irritable bowel syndrome in a fashion that is dependent on the presence of methane gas: subanalysis of a double-blind randomized controlled study. Dig Dis Sci, 2006, 51(8): 1297-1301.
26. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol, 2008, 32(2): 147-152.
27. Fennerty MB. Traditional therapies for irritable bowel syndrome: an evidence-based appraisal. Rev Gastroenterol Disord, 2003, 3(Suppl 2): S18-24.
28. Chang FY, Lu CL. Treatment of irritable bowel syndrome using complementary and alternative medicine. J Chin Med Assoc, 2009, 72(6): 294-300.
29. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med, 2003, 163(3): 265-274.

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