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TOPLINE
Among people with irritable bowel syndrome (IBS), more than half of those receiving fiber supplementation achieved a clinical response compared with 44% of those receiving placebo. Psyllium was associated with a greater clinical response than control.
METHODOLOGY
- Fiber supplements are often recommended as a first-line treatment for IBS, along with lifestyle changes and medications for specific symptoms, and patients usually find this treatment acceptable.
- Researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of fiber supplements vs placebo in adults with IBS. Eligible trials were conducted in community or outpatient settings.
- A total of 30 RCTs, including 1904 adults, were identified; 28 RCTs were included in the meta-analysis.
- Fiber types included wheat bran (n = 7), psyllium (n = 6), inulin-type fructans (n = 5), beta-galacto-oligosaccharides (n = 2), and various other fibers. Fiber supplements incorporated into foods were also considered. Treatment durations ranged from 7 days to 3 months, with fiber doses ranging from 1.4 to 30 g/d.
- The primary outcome was clinical response to fiber supplements; secondary outcomes were the effects of fiber supplements on gastrointestinal symptoms, stool frequency and consistency, and quality of life.
TAKEAWAY
- Clinical response occurred in 52% of participants receiving fiber vs 44% receiving placebo-like control (risk ratio [RR], 1.21; P = .02; I2 = 38%; 16 trials). Psyllium was associated with a greater clinical response than control (RR, 1.53; P = .02; I2 = 54%). Wheat bran did not result in a greater or worse clinical response.
- Fiber supplementation was associated with better clinical response than control in subgroup analyses of trials using doses ≤ 10 g/d (RR, 1.29; P = .04), as well as when provided as a supplement (RR, 1.23; P = .02) or in powder or granule form (RR, 1.23; P = .02).
- Beta-galacto-oligosaccharides were associated with improved overall gastrointestinal symptoms compared with control (standardized mean difference [SMD], -0.62; P = .02). Fiber given as powder or granules also showed an improvement in symptoms (SMD, -0.33; P = .02).
- There was no effect of fiber supplementation on bloating, abdominal pain, flatulence, or quality of life compared to controls. None of the reported common adverse events were attributed to fiber.
IN PRACTICE
"The findings of this systematic review and meta-analysis indicate the efficacy of fiber supplementation in relation to clinical response in IBS. Although overall and symptom-specific effects were limited, the greater global clinical response compared with placebo, particularly with psyllium, supports the continued recommendation of fiber as a first-line therapy for IBS," the authors wrote.
SOURCE
The study was led by Heidi M. Staudacher, PhD, School of Translational Medicine, Monash University, Melbourne, Australia. It was published online on August 14 in Gastroenterology.
LIMITATIONS
The exclusive focus on fiber supplements limited the applicability of the findings. Fewer than half of trials reported adherence, and adverse events were reported in less than 30% of trials. All trials had a moderate or high risk for bias, mainly relating to lack of between-group analyses or intention-to-treat approaches.
DISCLOSURES
One author reported being supported by a National Health and Medical Research Council Investigator Grant and receiving research funding, honoraria, and travel funding from various sources. Another author reported receiving research grants and serving as a consultant, and a third author reported receiving research grants and speaker fees, holding a joint patent for using volatile organic compounds as biomarkers in IBS, and receiving royalties from Wiley Publishing.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
