Developing Irritable Bowel Syndrome Guidelines Through Meta-analyses: Does the Emperor Really Have New Clothes?
published online 29 July 2009.
Clinical guidelines are often based on systematic reviews and meta-analyses. There have been many such meta-analyses regarding the treatment of irritable bowel syndrome (IBS), even though individual high quality studies used in these meta-analyses are sparse. The American College of Gastroenterology (ACG) IBS Task Force1 recently conducted a comprehensive, methodologically sound appraisal of all therapeutic modalities used in IBS based on meta-analyses of each therapeutic class, and published an evidence-based position statement on the management of IBS. The significant effort in systematically analyzing the evidence is enhanced by the interpretation by several experts forming the task force under the auspices of a national organization. The report has a carefully worded abstract that identifies pitfalls. For example, the text specifies:
1.“Trials suggest psyllium fiber, certain antispasmodics, and peppermint oil are effective in IBS patients … although the quality of the evidence is poor.”
2.“Some probiotics may be effective in reducing overall IBS symptoms, … but more data are needed.”
3.“Tricyclic antidepressants and selective serotonin reuptake inhibitors have been shown to be effective in IBS patients of all subtypes … trials generally are of good quality but the limited number of patients included in trials. …”
4.“Psychological therapies may also provide benefit to IBS patients although the quality of evidence is poor.”
aCENTER Program, College of Medicine, Mayo Clinic, Rochester, Minnesota
bCenter for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California
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