Comparison: tricyclics versus placebo

OutcomeMeta-analysis Evidence detailsSummary Statisticsp(hetero) and 12Comments:Study QualityDirectnessImprecisionInconsistencyReporting BiasGRADE CommentsRating
Global improvement of IBS symptoms (no. patients)3 trials; 180 patients; from meta-analysisRR=1.31 (95%CI 1.04, 1.64)p=0.27; I2 =23%Statistically significant in favour of tricyclics. NNT 6, for control group rate 22–68%GoodIndirect setting- minor, secondary care OPDPreciseConsistent---1/3 was CCT. 2/3 had some patients with depression. 1/3 primary care.Moderate
Global IBS symptom score1 trial; 28 patients; from RCTMD=−8.86 (95%CI −24.02, 6.3)Not statistically significant; scale not givenGoodIndirect setting- minor, secondary care OPDSparse dataConsistent---Small study (28 patients). Setting not stated. Drug from industry. Severe and refractory IBS. >5% with depression.Moderate
No of patients with less pain2 trials; 84 patients; from meta-analysisRR=3.91 (95%CI 1.93, 7.93)p=0.81; I2 =0%Statistically significant, favours tricyclic NNT 2, for control group rate 16–18%.GoodIndirect patients - minor, closely related conditnFairly wide CIConsistent---60% IBS in 1/2 studies (Tanum & Malt); 24% dropouts in other (Vij). Secondary care. 1/2 had patients with depression; 1/2 had refractory IBS.Moderate
Pain score1 trial; 47 patients; from RCTMD=−25.9 (95%CI −38.82, −12.98)Statistically significant, favours tricyclic; scale 100GoodIndirect patients - minor, comorbidityPreciseConsistent---Tanum & Malt 60% patients IBS. Secondary care; refractory IBSModerate
Improvement in pain score1 trial; 79 patients; from RCTmedian diff=0.3 (95%CI 0, 0)Statistically significant in favour of antidepressant; p<0.05; scale 0–4GoodIndirect setting- minor, secondary care OPDPreciseConsistent---Primary and secondary care; some patients had depression. Detail limited - German translationModerate
Improvement in feeling of fullness1 trial; 79 patients; from RCTMedian diff=0.23 (95%CI 0, 0)Not statistically significant; scale 0–4GoodIndirect setting- minor, secondary care OPDPreciseConsistent---Primary and secondary care; some patients had depression. Detail limited - German translationModerate
No of patients with improved bowel habit1 trial; 44 patients; from RCTRR=2.41 (95%CI 1, 5.79)borderline significance; favours tricyclic; wide CIGoodIndirect setting- minor, secondary care OPDWide CIConsistent---Wide CI. 57% psychiatric comorbidities; secondary care.Low

From: Appendix F, Grading the evidence

Cover of Irritable Bowel Syndrome in Adults
Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet].
NICE Clinical Guidelines, No. 61.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2008, Royal College of Nursing.

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