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.
目的:观察帕罗西汀治疗非便秘型肠易激综合征的临床疗效。方法:符合罗马Ⅲ诊断标准的非便秘型肠易激综合征患者107例,随机分为2组,治疗组57例,给予帕罗西汀20 mg,每日晨起顿服,匹维溴铵50 mg,3次/d,口服;对照组50例,给予谷维素30 mg, 3次/d,口服,匹维溴铵50 mg,3次/d,口服,疗程4周。观察患者腹痛、腹泻、腹部不适、排便次数、大便性状,以及焦虑、抑郁等改善情况。结果:治疗组总有效率为930%,对照组总有效率为760%,两组比较差异有统计学意义(Plt;001)。结论:帕罗西汀治疗非便秘型肠易激综合征有明确的临床意义。
Objective To evaluate the efficacy and safety of Tongxiening granule （TXNG） in the treatment of diarrhea-predominant irritable bowel syndrome （IBS） （stagnation of the liver-qi attacking the spleen）. Methods In a prospective, randomized, placebo-controlled, double-blind clinical trial, 60 patients with diarrhea-predominant IBS were randomly divided into the TXNG group （TXNG, 5.0g, 3 times daily; n =30） and the placebo group （placebo, 5. 0g, 3 times daily; n =30）. The treatment was administered for 3 weeks, and the follow-up was conducted for 4 weeks.Results （1）Abdominal pain： The cure rates were 57. 7% vs. 16. 0% （ by per-protocol analysis, PP） and 31.0% vs. 7.1% （ by intention-to-treat analysis （ITT） ; and the overall improvement rates were 92.3% vs. 44.0% （PP） and 82.7% vs. 39.3% （ITT） in the TXNG and the placebo groups respectively （ P 〈0. 05）. （2） Diarrhea ： the cure rates were 46. 2% vs. 20. 0% （PP） and 41.4% vs. 17. 9% （ITT） , and the overall improvement rates were 96. 2% vs 48. 0% （PP） and 86. 2% vs 42.9% （ITT） in the two groups respectively （P 〈0.05）. （3）Traditional Chinese medicine symptoms： the cure rates were 30.8% vs. 4.0% （PP） and 27.6% vs. 3.6% （ITT） ; and the overall improevment rates were 92.3% vs. 48.0% （PP） and 82.7% vs 42.9% （ITT） in the two groups respectively （P 〈0. 05）. The pain duration after treatment in the TXNG group was significantly shortened compared with the placebo group （7.6 ±4. 6d vs 14. 4 ±4. 3d, P =0. 0125）. After 4-week follow-up, it suggested that the recrudescent duration in symptoms related to IBS in the TXNG group was longer than that in the placebo group （11.5 ±5.3 d vs 6.2 ±6.9 d, P = 0. 019）. No adverse effects were found in the TXNG group. Conclusion It was demonstrated that TXNG is effective and safe in the treatment of diarrhea-predominant ms （stagnation of the liver-qi attacking the spleen）.
Objective To compare the clinical therapeutic effect of probiotic agents in treating irritable bowel syndrome (IBS) by Meta-analysis. Methods Such databases as MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Chinese Biomedical Literature Database were searched from January 2001 to October 2011, and the domestic conference proceedings and relevant papers published in recent 1 year were also searched manually. All domestic randomized controlled trials (RCTs) on probiotic agents in treating irritable bowel syndrome (IBS) were collected, which were then selected according to the inclusion and exclusion criteria. The data were extracted, the methodological quality of the included studies was assessed, and the Meta-analysis was performed with Revman5.0. Results A total of 11 RCTs involving 1 065 patients were included. The total effective rate of the probiotic agents plus conventional treatment group was superior to that of the conventional treatment (trimebutine meleate/ pinaverium bromide) group (RR=1.26, 95%CI 1.18 to 1.34, Plt;0.000 01), it could effectively relieve abdominal pain (RR=1.10, 95%CI 1.03 to 1.18, P=0.004) and diarrhea (RR=1.15, 95%CI 1.07 to 1.24, P=0.000 3). But there was no significant difference between the two groups in alleviating abdominal distention (RR=1.08, 95%CI 0.95 to 1.24, P=0.25). The effectiveness of probiotic agents used alone was similar to that of the conventional treatment used alone, without significant differences (RR=0.85, 95%CI 0.66 to 1.09, P=0.19). Conclusion Probiotic agents combined with conventional drugs can improve the total therapeutic effect of IBS, especially in alleviating abdominal pain, diarrhea and so on. But the effectiveness of probiotic agents used alone is similar to that of the conventional treatment used alone. For the possibility of bias due to the lower quality of the included studies and unclear implementation of RCTs, this conclusion should be verified with more large-scale and high-quality RCTs.
Objective To evaluate the efficacy and safety of rifaximin in the treatment of irritable bowel syndrome (IBS). Methods The computer system was used to retrieve PubMed, Embase, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases, and the randomized controlled trials of rifaximin for IBS published before November 30, 2022 were retrieved. The data were meta-analysed using RevMan 5.1 and Stata 12.0 softwares. Results Finally, 8 studies including 5176 patients were included. Meta-analysis results showed that the overall effective rate [relative risk (RR)=1.40, 95% confidence interval (CI) (1.21, 1.62), P<0.00001], abdominal pain relief rate [RR=1.21, 95%CI (1.12, 1.32), P<0.00001], abdominal distension relief rate [RR=1.28, 95%CI (1.15, 1.41), P<0.00001], and stool character improvement rate [RR=1.20, 95%CI (1.10, 1.32), P<0.0001] of rifaximin in the treatment of IBS were better than those of the control group. There was no significant difference in the incidence of adverse reactions (P>0.05). Conclusion Rifaximin can effectively improve the abdominal pain, abdominal distension and stool characteristics of IBS patients, and it is safe and reliable.
ObjectiveTo systematically review the efficacy and safety of selective calcium channel blockers (SCCBs) versus placebo for irritable bowel syndrome (IBS) patients. MethodsWe searched databases including PubMed, EMbase, the Cochrane Library, CBM, WanFang Data, VIP and CNKI for relevant randomized controlled trials (RCTs) of SCCB versus placebo for IBS patients from inception to August, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsA total of 12 RCTs involving 1 325 patients were included. The results of meta-analysis showed that: The total effective rate (RR=2.06, 95%CI 1.56 to 2.73, P<0.000 01, NNT=3), abdominal pain remission rate (RR=1.47, 95%CI 1.31 to 1.65, P<0.000 01, NNT=5), and abdominal distension remission rate (RR=1.48, 95%CI 1.10 to 2.00, P=0.01, NNT=5) in the SCCB group were significantly higher than those in the placebo group. The adverse reaction rate of the SCCB group was also significantly higher than that of the placebo group (RD=3%, 95%CI 2% to 4%, P=0.002), but all adverse reactions of the SCCB group were minor. Subgroup analysis based on different SCCBs showed that there were no significant differences between the otilonium bromide subgroup and the pinaverium bromide subgroup in above outcomes (all P values >0.05). ConclusionCurrent evidence shows that SCCBs can improve the symptoms of IBS with minor side-effects. Due to limited quality and quantity of included studies, more large-scale high-quality studies are needed to verify the above conclusion.
Objective To evaluate the reliability and validity of IBS-QOL scale in irritable bowel syndrome (IBS) patients. Methods IBS-QOL scale was applied to survey the quality of life of 123 IBS patients. The split-half and internal consistency method were used to evaluate the reliability, and with the construct method to evaluate the validity. Results The split-half reliability was 0.86. Cronbach’s α-coefficient of all domains was between 0.71 and 0.89 except body image and food avoidance; In the correlation analysis, the correlations between items and its subscale structure were above 0.60 (except interference with activity), but there were no correlations between items and other subscale structure. Eight components from factorial analysis were in accordance with theoretical structure.The cumulative contribution rate was 72.7%. Conclusions The reliability and validity of IBS-QOL scale are acceptable. It might be useful for us to assess the QOL of IBS patients in China.