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

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    Authors
    Ford, A C
    Talley, N J
    Schoenfeld, P S
    Quigley, E M M
    Moayyedi, P
    Affiliation
    Gastroenterology Division, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. alexf12399@yahoo.com
    Issue Date
    2009-03
    MeSH
    Adult
    Antidepressive Agents
    Cognitive Therapy
    Combined Modality Therapy
    Female
    Humans
    Irritable Bowel Syndrome
    Male
    Placebos
    Practice Guidelines as Topic
    Randomized Controlled Trials as Topic
    Treatment Outcome
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    Citation
    Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. 2009, 58 (3):367-78 Gut
    Journal
    Gut
    URI
    http://hdl.handle.net/10147/201247
    DOI
    10.1136/gut.2008.163162
    PubMed ID
    19001059
    Abstract
    Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence for treatment of the condition with antidepressants and psychological therapies is conflicting.
    Systematic review and meta-analysis of randomised controlled trials (RCTs). MEDLINE, EMBASE and the Cochrane Controlled Trials Register were searched (up to May 2008).
    RCTs based in primary, secondary and tertiary care.
    Adults with IBS.
    Antidepressants versus placebo, and psychological therapies versus control therapy or "usual management".
    Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). The number needed to treat (NNT) was calculated from the reciprocal of the risk difference.
    The search strategy identified 571 citations. Thirty-two RCTs were eligible for inclusion: 19 compared psychological therapies with control therapy or "usual management", 12 compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Study quality was generally good for antidepressant but poor for psychological therapy trials. The RR of IBS symptoms persisting with antidepressants versus placebo was 0.66 (95% CI, 0.57 to 0.78), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms persisting with psychological therapies was 0.67 (95% CI, 0.57 to 0.79). The NNT was 4 for both interventions.
    Antidepressants are effective in the treatment of IBS. There is less high-quality evidence for routine use of psychological therapies in IBS, but available data suggest these may be of comparable efficacy.
    Item Type
    Article
    Language
    en
    ISSN
    1468-3288
    ae974a485f413a2113503eed53cd6c53
    10.1136/gut.2008.163162
    Scopus Count
    Collections
    Cork University Hospital

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