review and meta-analysis therapies in irritable bowel syndrome: systematic Efficacy of antidepressants and psychological

ABSTRACTObjective: Irritable bowel syndrome (IBS) is a chronicfunctional gastrointestinal disorder. Evidence for treat-ment of the condition with antidepressants and psycho-logical therapies is conflicting.Design: Systematic review and meta-analysis of rando-mised controlled trials (RCTs). MEDLINE, EMBASE and theCochrane Controlled Trials Register were searched (up toMay 2008).Setting: RCTs based in primary, secondary and tertiarycare.Patients: Adults with IBS.Interventions: Antidepressants versus placebo, andpsychological therapies versus control therapy or ‘‘usualmanagement’’.Main outcome measures: Dichotomous symptom datawere pooled to obtain a relative risk (RR) of remainingsymptomatic after therapy, with a 95% confidenceinterval (CI). The number needed to treat (NNT) wascalculated from the reciprocal of the risk difference.Results: The search strategy identified 571 citations.Thirty-two RCTs were eligible for inclusion: 19 comparedpsychological therapies with control therapy or ‘‘usualmanagement’’, 12 compared antidepressants with pla-cebo, and one compared both psychological therapy andantidepressants with placebo. Study quality was generallygood for antidepressant but poor for psychological therapytrials. The RR of IBS symptoms persisting withantidepressants versus placebo was 0.66 (95% CI, 0.57to 0.78), with similar treatment effects for both tricyclicantidepressants and selective serotonin reuptake inhibi-tors. The RR of symptoms persisting with psychologicaltherapies was 0.67 (95% CI, 0.57 to 0.79). The NNT was4 for both interventions.Conclusions: Antidepressants are effective in thetreatment of IBS. There is less high-quality evidence forroutine use of psychological therapies in IBS, but availabledata suggest these may be of comparable efficacy.Irritable bowel syndrome (IBS) is a functionalgastrointestinal (GI) disorder for which there is noknown structural or anatomical explanation. Theprevalence of IBS in the general population isestimated to be between 5% and 20%,