The place of antibiotics in management of irritable bowel syndrome: a systematic review and meta-analysis

INTRODUCTION: Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disease with an obscure pathophysiology. Current treatments for IBS have modest efficacy at best and the need for a robust therapy for IBS remains unmet. As small intestinal bacterial overgrowth has been proposed to be involved in pathogenesis of IBS, antibacterial agents might be efficacious in treatment of this condition. MATERIAL AND METHODS: PubMed, Embase, Scopus, Google Scholar, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies comparing the efficacy of antibiotics in the management of IBS and/or IBS type symptoms. Data were collected from 1966 to April 2009. Clinical response was considered as our key outcome of interest. RESULTS: Of five trials that evaluated the effect of antibiotics in IBS, two randomized placebo-controlled trials met the inclusion criteria for the meta-analysis. This meta-analysis included 234 patients with IBS-type symptoms of whom 181 met the Rome criteria for IBS. The pooled relative risk (RR) for “clinical response in IBS” was 2.04 (95% confidence interval [CI] of 1.23-3.40, p = 0.0061). The pooled RR for “clinical response in IBS-type symptoms” was 2.06 (95% CI of 1.3-3.27, p = 0.002). CONCLUSIONS: Although antibiotics have a statistically significant effect on IBS and bloating, given the evidence for the presence of publication bias, methodological variability of the trials and lack of a precise scientific explanation for the role of bacterial overgrowth in the pathophysiology of IBS, use of antibiotics on a regular basis in IBS patients is not recommended.