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A faulty production line

CBT should not be last resort for irritable bowel syndrome

By Nigel Praities

GPs should not reserve cognitive behaviour as a last resort in the treatment of irritable bowel syndrome, say primary care experts.

A new meta-analyses on the effective of different treatments for IBS found antidepressants and psychological therapies were of ‘comparable efficacy'.

The analysis - published online by Gut – found the relative risk of IBS symptoms was reduced by 34% by antidepressants and 33% for psychological therapy, and the numbers needed to treat were four for both interventions.

NICE currently recommends tricyclic antidepressants are used second-line treatment for people with IBS if laxatives, loperamide or antispasmodics have not helped.

Psychological therapies are restricted to those who do not respond to pharmacological therapies after a year and have developed refractory IBS.

But Professor Roger Jones, professor of general practice at King's College London, who has researched the effectiveness of psychological therapies in IBS, said they needed to be made more available for GPs and their position in guidelines strengthened.

‘We leave it to the bottom drawer as a last resort. In certain patients who have an understanding that this is a modifiable condition that relates to their state of mind, why wait to refer them until their illness gets worse?' he said.

The Canadian researchers also reviewed other therapies for IBS, including antispasmodics, fibre supplements and peppermint oil.

In a meta-analysis of 22 studies, published online by the BMJ, they found all three treatments were effective for IBS and encouraged their use in routine practice.

This analysis should ‘reawaken interest in the pharmacotherapy of IBS and stimulate further research' said Professor Jones.

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