Peppermint Oil, Fiber Can Fight Irritable Bowel

In trials comparing fiber with placebo, insoluble fiber such as bran was not effective. Instead, only soluble fiber, such as ispaghula husk, reduced symptoms. For antispasmodics, the most effective was hyoscine. This should be used first among antispasmodics, Ford's group advised.

"Physicians, particularly those in primary care, who are being asked to take increasing responsibility for the management of IBS, should consider the use of these agents as first-line therapies for IBS," Ford said.

Dr. Roger Jones, from Kings College London and author of an accompanying journal editorial, welcomed the study.

"These treatments might be slightly more effective than recently thought and they are worth trying," Jones said.

For some patients with pain and diarrhea the antispasmodics may be useful. Patients with constipation should try fiber and for other patients, peppermint oil may be helpful, Jones said.

"If you have IBS which is not under reasonably good control or you are not happy with your symptom profile, you should see your primary-care doc or gastroenterologist for review and perhaps remind them that there is new evidence about the effectiveness of these traditional medicines and you would like to give it a go," Jones said.

"Alternatively, if you feel sufficiently well-informed and confident, you can go do it yourself and get these treatments at the pharmacy," Jones added.

More information

For more information on IBS, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Alex Ford, M.D., McMaster University, Health Sciences Centre, Ontario, Canada; Roger Jones, M.D., Kings College London, London; Nov. 14, 2008, BMJ, online