Universidade Metropolitana de Santos (UNIMES), Departamento de Medicina, Santos, SP, Brasil.
Arq Gastroenterol. 2021 Jan-Mar;58(1):120-126. doi: 10.1590/S0004-2803.202100000-20.
Irritable bowel syndrome (IBS) is a complex gastrointestinal disorder, whose understanding is relatively uncertain, and the treatment guidance decision still represents a challenge.
To identify and critically appraise systematic reviews (SRs) published in the Cochrane Database of SRs (CDSR) on the effects of interventions (pharmacological and non-pharmacological) for the treatment of IBS.
The search was conducted at the Cochrane Library in May 2020. The methodological quality of the SRs was evaluated by the AMSTAR-2 tool.
Eight SRs with moderate to high quality were included, which addressed the treatments: (a) pharmacological: volume agents, antispasmodics, antidepressants and tegaserod; and (b) non-pharmacological: homeopathy, acupuncture, phytotherapy, biofeedback, psychological interventions and hypnotherapy. The results were favorable to antispasmodic drugs and antidepressants regarding the improvement of clinical symptoms. There was no difference between volume agents or tegaserod when compared to placebo. Acupuncture and homeopathy showed a little improvement in symptoms compared to placebo, but the certainty of this evidence was considered low to very low. Psychological interventions seem to improve the overall assessment of the patient and relief symptoms such as abdominal pain. However, there was no long-term follow-up of these patients. The results of the other treatments were considered uncertain due to the high risk of bias.
Considering the low quality of the studies included in the SRs, pharmacological treatment with antispasmodics and antidepressants seems to be beneficial for patients with IBS. Among non-pharmacological interventions, psychological interventions seem to be beneficial. However, further clinical trials are recommended with greater methodological rigor to prove these findings.
肠易激综合征（IBS）是一种复杂的胃肠道疾病，其发病机制尚不完全明确，治疗方案的选择仍然具有挑战性。
识别和评价发表在 Cochrane 系统评价数据库（CDSR）中关于治疗 IBS 的干预措施（药物和非药物）效果的系统评价。
2020 年 5 月在 Cochrane 图书馆进行检索。采用 AMSTAR-2 工具评价系统评价的方法学质量。
共纳入 8 篇质量为中高度的系统评价，涉及以下治疗方法：（a）药物治疗：容积性药物、抗痉挛药物、抗抑郁药和替加色罗；（b）非药物治疗：顺势疗法、针灸、植物药治疗、生物反馈、心理干预和催眠疗法。抗痉挛药物和抗抑郁药在改善临床症状方面的效果优于安慰剂。容积性药物和替加色罗与安慰剂相比，没有差异。与安慰剂相比，针灸和顺势疗法在改善症状方面有一定的效果，但证据的确定性被认为是低到极低。心理干预似乎可以改善患者的整体评估和缓解腹痛等症状。然而，这些患者没有长期随访。由于偏倚风险高，其他治疗方法的结果被认为不确定。
考虑到纳入的系统评价研究质量较低，药物治疗中使用抗痉挛药物和抗抑郁药似乎对 IBS 患者有益。在非药物干预中，心理干预似乎有益。然而，需要进一步进行方法学严谨的临床试验来证实这些发现。
