Guidelines for the management of irritable bowel syndrome in the United Kingdom recommend that the diagnosis should be made on clinical grounds alone, without invasive investigations, unless alarm symptoms such as rectal bleeding are present. General practitioners therefore need efficacious treatments that do not require monitoring and are cheap, safe, and readily available. People with irritable bowel syndrome have been instructed to increase their intake of dietary fibre. When this failed, smooth muscle relaxants and antispasmodics were used. More recently, peppermint oil, shown to have antispasmodic – properties has been used to treat irritable bowel syndrome. Whether these agents are effective in treating
irritable bowel syndrome is controversial. Results of randomised controlled trials are conflicting and systematic reviews have come to different conclusions.
Ford et al 2008 BMJ carried out a systematic review and meta-analysis to determine the effect of fibre, antispasmodics, and peppermint oil in the treatment of
irritable bowel syndrome.
They concluded that fibre, antispasmodics and peppermint oil were all more effective than placebo in treating the symptoms of irritable bowel.
This is an important analysis of the treatment of a common and troublesome condition.
Ford et al 2008 Effect of fibre, antispasmodics and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ vol 337 pp 1388-92

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Martin Eastwood

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