Meta-analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome

Aim: To update previous overviews of placebo-controlled double-blind trials assessing the efficacy and tolerance of smooth muscle relaxants in irritable bowel syndrome. Methods and trials: A total of 23 randomized clinical trials were selected for meta-analyses of their efficacy and tolerance. Six drugs were analysed: cimetropium bromide (five trials), hyoscine butyl bromide (three trials), mebeverine (five trials), otilium bromide (four trials), pinaverium bromide (two trials) and trimebutine (four trials). The total number of patients included was 1888, of which 945 received an active drug and 943 a placebo. Results: The mean percentage of patients with global improvement was 38% in the placebo group (n = 925) and 56% in the myorelaxant group (n = 927), in favour of myorelaxants with a mean odds ratio of 2.13, P < 0.001 (95% CI: 1.77-2.58) and a mean risk difference of 22% P < 0.001 (95% CI: 13-32%). The percentage of patients with pain improvement was 41% in the placebo group (n=568) and 53% in the myorelaxant group (n = 567): odds ratio 1.65, P < 0.001 (95% CI: 1.30-2.10) and risk difference 18%, P < 0.001 (95% CI: 7-28%). There was no significant difference for adverse events. Conclusion: Myorelaxants are superior to placebo in the management of irritable bowel syndrome.