Reaching a consensus on irritable bowel syndrome

[The authors respond:]

We agree with Russell Springate that input from patients suffering from irritable bowel syndrome is very important. However, the purpose of our meeting was to critically examine the current medical literature on the management of irritable bowel syndrome to develop evidence-based guidelines for use by family physicians. A small subgroup of the participants in the consensus conference convened a focus group meeting with a number of patients with irritable bowel syndrome in advance of the conference. The ideas and concerns expressed by these patients were discussed in the small group sessions and taken into consideration as we developed our recommendations.

Paul Lépine points out that we did not mention peppermint oil as one of the antispasmodic agents with potential benefit in the treatment of irritable bowel syndrome. To provide a concise review for family practitioners, we made no attempt to be all inclusive in our discussion of drug therapy, and in fact we did not mention over a dozen other antispasmodic agents that have been subjected to clinical trials in irritable bowel syndrome. It is interesting that although Lépine's MEDLINE search uncovered 33 817 documents on irritable bowel syndrome and peppermint oil, Pittler and Ernst1 included only 5 double-blind, placebo-controlled, randomized controlled trials in their metaanalysis and they concluded that "in view of the methodological flaws associated with most studies, no definitive judgement about efficacy can be given." This underscores the need, as stated in our paper, for proper prospective randomized controlled trials in irritable bowel syndrome that include well-validated outcome measures.

Competing interests: The Queen's University Gastrointestinal Motility Education Centre is sponsored by an unrestricted educational grant from Janssen-Ortho Inc. Other pharmaceutical sponsors for the consensus conference project were Glaxo Wellcome Inc., Jouveinal Canada Inc., Pfizer Canada Inc., Solvay Pharma, Hoffmann-LaRoche Ltd., and Procter and Gamble Pharmaceuticals Canada Inc. Authors who were not members of the Queen's University Gastrointestinal Motility Education Centre received an honorarium and travel expenses from the centre. Drs. Paterson and Vanner have received speaker fees from Janssen-Ortho unrelated to this consensus conference.