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Irritable bowel syndrome (Editorial)

How the items making up any issue of Bandolier come together is a bit of a mystery. Increasingly it comes about that questions posed by readers are matched, in time, by evidence that emerges from systematic reviews or good quality trials. This issue seems more devoted to questions posed, but where the answers fail to arrive. Sometimes, though, the answers themselves pose problems.

Irritable bowel syndrome


IBS is common, difficult to diagnose, and with few effective remedies. Most people who have it don't even see a doctor, but it still costs the NHS about £50 million a year [1]. Bandolier is consistently asked for help, and consistently fails to find any good evidence.

We found one recent report providing foods for thought [2]. Twenty consecutive patients with persistent watery or loose stools 4-15 times a day for three months to 20 years (median one year) had only limited relief from previous conventional IBS therapies. Within three days of starting of starting treatment with histamine antagonist or proton pump inhibitor, the diarrhoea and urgency abated, with one to three formed stools a day and amelioration of symptoms. Five patients stopped treatment with prompt return of diarrhoea, again relieved by treatment.

Now as best Bandolier can judge there is no more evidence. Pharmaceutical companies making acid suppressants had not heard of this. That's it. There's no more. What do we do? At least acid suppressants are not grapefruit seed extract , and we know a lot about safety. But do we just wait for some trials?

References:

  1. NE Wells, BA Hahn, PJ Whorwell. Clinical economics review. Aliment Pharmacol Ther 1997 11: 1019-1030.
  2. B Dave, W Rubin. Inhibition of gastric secretion relieves diarrhea and postprandial urgency associated with irritable bowel syndrome or functional diarrhea. Digestive Diseases and Sciences 1999 44: 1893-1898.


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