LoveISA

可溶性纖維對於IBS症狀可能有效

作者：Laurie Barclay, MD

出處：WebMD醫學新聞

　　September 9, 2009 — 根據8月28日線上初版BMJ報導的一篇隨機、安慰劑控制試驗結果，可溶性纖維(洋車前子)對於緩解大腸激躁症(irritable bowel syndrome，IBS)症狀可能有效，而不溶性的纖維(麩皮)則會惡化症狀。
　　荷蘭Utrecht大學醫學中心的C.J. Bijkerk醫師等人寫道，對於大腸激躁症的處置，通常是給予飲食建議。多數的一般開業醫師建議增加飲食中的纖維量，增加不溶性的麩皮纖維。再者，將近半數大腸激躁症患者接受藥物治療，通常包括以洋車前子為主的補充品。
　　研究目標在評估增加膳食中可溶性纖維(洋車前子)或不溶性纖維(麩皮)的含量，對於IBS病患之症狀的影響。
　　在一般開業醫師的病患中，275名年紀18至65歲的IBS病患被指定接受12週的治療，使用10 g的洋車前子(n = 85人)或10 g的麩皮(n = 97人)或10 g的安慰劑(米粉；n = 93人)。研究的主要結果是在前一個月最後兩週時的適當症狀緩解。為了確認短期和持續的效果，在治療後的第一、二、三個月進行結果測量。次級結果包括IBS症狀嚴重度分數、腹部疼痛嚴重度、IBS生活品質量表。
　　相較於安慰劑組，洋車前子組在第一個月時有顯著較多的人有反應(57% vs 35%；相對風險[RR]1.60；95%信心區間[CI]1.13 - 2.26) 、第二個月時也是較多(59% vs 41%；RR，1.44；95% CI，1.02 - 2.06)。單就第三個月的治療而言，麩皮比安慰劑更有效(57% vs 32%；RR，1.70；95% CI，1.12 - 2.57)。不過，在最壞情況分析時，並無統計上的顯著程度(RR，1.45；95% CI，0.97 - 2.16)。
　　治療三個月之後，洋車前子組的症狀嚴重度減少90分，安慰劑組減少49分(P = .03)、麩皮組減少58分(相較於安慰劑組的P值 = .61)。三組的生活品質分數相似。洋車前子組有54人(64%)完成三個月治療期間，麩皮組有54人(56%)，安慰劑組有56人(60%)完成。
　　作者們寫道，洋車前子在一級照護上提供大腸激躁症的治療利益。麩皮組提早退出試驗者較多；主要理由是大腸激躁症症狀惡化。
　　研究限制包括取樣偏差影響了一般性，病患不知情情況不完整、退出率高。
　　作者們寫道，洋車前子的治療利益對於大腸激躁症羅馬準則第二版的病患比較大。麩皮可能會惡化大腸激躁症症狀，特別是治療開始時，在建議同時必須提供警訊。
　　荷蘭健康研究與發展組織提供本研究的同儕回顧資金。荷蘭的Pfizer BV公司提供研究用的洋車前子。研究作者宣告沒有相關財務關係。

Soluble Fiber May Be Effective for Symptoms of IBS

By Laurie Barclay, MD
Medscape Medical News

September 9, 2009 — Soluble fiber (psyllium) may effectively relieve symptoms of irritable bowel syndrome (IBS), but insoluble fiber (bran) may worsen symptoms, according to the results of a randomized, placebo-controlled trial reported in the August 28 Online First issue of the BMJ.

"In the management of irritable bowel syndrome, dietary advice is often given," write C.J. Bijkerk, MD, from University Medical Center Utrecht in Utrecht, the Netherlands, and colleagues. "Most general practitioners recommend an increase in the fibre content of the daily diet, through the addition of insoluble fibre in the form of bran. Furthermore, approximately half of patients with irritable bowel syndrome receive drug treatment, often including psyllium based supplements."

The goal of this study was to evaluate the efficacy of increasing the dietary content of soluble fiber (psyllium) or insoluble fiber (bran) in patients with IBS.

In a general practice setting, 275 patients aged 18 to 65 years with IBS were assigned to 12 weeks of treatment with 10 g of psyllium (n = 85), 10 g of bran (n = 97), or 10 g of placebo (rice flour; n = 93). The main outcome of the study was adequate symptom relief during at least 2 weeks in the previous month. To determine both short-term and sustained efficacy, this outcome was measured after 1, 2, and 3 months of treatment. Secondary outcome measures were IBS symptom severity score, abdominal pain severity, and IBS quality-of-life scale.

Compared with the placebo group, the psyllium group had a significantly greater proportion of responders during the first month (57% vs 35%; relative risk [RR], 1.60; 95% confidence interval [CI], 1.13 - 2.26) and the second month of treatment (59% vs 41%; RR, 1.44; 95% CI, 1.02 - 2.06). During the third month of treatment only, bran was more effective than placebo (57% vs 32%; RR, 1.70; 95% CI, 1.12 - 2.57). However, this was not statistically significant in the worst-case analysis (RR, 1.45; 95% CI, 0.97 - 2.16).

Symptom severity in the psyllium group was reduced by 90 points after 3 months of treatment vs 49 points in the placebo group (P = .03) and 58 points in the bran group (P = .61 vs placebo). Quality of life was similar in all 3 groups. The 3-month treatment period was completed by 54 (64%) of the patients assigned to psyllium, 54 (56%) in the bran group, and 56 (60%) in the placebo group.

"Psyllium offers benefits in patients with irritable bowel syndrome in primary care," the study authors write. "Early dropout was most common in the bran group; the main reason was that the symptoms of irritable bowel syndrome worsened."

Limitations of this study include selection bias affecting generalizability, incomplete patient blinding, and high dropout rate.

"The benefit of psyllium may be somewhat greater in patients who fulfill the Rome II criteria for irritable bowel syndrome," the study authors conclude. "Bran may worsen symptoms of irritable bowel syndrome, especially at the beginning of treatment, and should be advised only with caution."

The Netherlands Organisation for Health Research and Development provided peer-reviewed funding for this study. Pfizer BV, the Netherlands, delivered psyllium for this study. The study authors have disclosed no relevant financial relationships.

BMJ. 2009;339:b3154.

資料來源: http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=5875&x_classno=0