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The Role of Psyllium Fibre Supplementation

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In Treating Irritable Bowel Syndrome

LAURA E. CHOUINARD, BASc, RD, Department of Family Relations and Applied Nutrition,
University of Guelph, Guelph, ON

ABSTRACT Résumé
North American family physicians and dietitians commonly Il demeure assez courant pour les médecins de famille et
recommend psyllium fibre supplementation for treating les diététistes de l’Amérique du Nord de recommander une
symptoms of irritable bowel syndrome (IBS). In this review, supplémentation en fibres de psyllium pour le traitement des
evidence on the effectiveness of psyllium supplementation for symptômes du syndrome du côlon irritable (SCI). L’objectif de
diagnosed IBS symptoms was evaluated and summarized. A cette revue était d’évaluer et de résumer l’état des données
systematic search of MEDLINE, CINAHL, and Web of Science was probantes relativement à l’efficacité d’une supplémentation
conducted. Included were full-length, peer-reviewed, English- en psyllium sur les symptômes du SCI chez les personnes en
language articles in which psyllium ingestion was tested for its ayant reçu le diagnostic. Une recherche systématique dans
For personal use only.

effect on IBS symptoms. Quality of these articles also was MEDLINE, CINAHL et Web of Science a été menée. Les articles
assessed. Twelve met the criteria for complete data abstraction. intégraux, en langue anglaise et révisés par des pairs ont été
Seventy-five percent of the studies examined were of weak inclus lorsque l’ingestion de psyllium était évaluée afin de
quality. Study designs and methods were heterogeneous. déterminer ses effets sur les symptômes du SCI. Une évaluation
Patient-perceived global symptoms improved significantly in six de la qualité des articles satisfaisant aux critères ci-dessus a
of the nine studies measuring a global symptom outcome. In été effectuée. Douze articles satisfaisaient aux critères pour une
one study, significant improvements occurred in reported abstraction complète des données. Soixante-quinze pour cent
abdominal pain; in three, improvement did not occur. Quality of des études évaluées étaient de faible qualité. De plus, les plans
life and flatulence did not improve significantly in any studies in et méthodologies des études étaient hétérogènes. Une amé-
which these outcomes were examined. The results of this lioration globale significative de l’amélioration des symptômes
systematic review indicate limited and conflicting evidence to perçus par les patients a été notée dans six des neuf études
support the recommendation of psyllium supplementation for mesurant un résultat relatif aux symptômes globaux. Une étude
symptomatic IBS treatment. a rapporté des améliorations significatives quant à la douleur
abdominale rapportée, tandis que trois n’ont pas fait men-
(Can J Diet Pract Res. 2011;72:48)
tion de ce type d’amélioration. Dans les études examinant ces
(DOI: 10.3148/72.1.2011.48)
résultats, aucune amélioration significative n’a été rapportée
en matière de qualité de vie et de flatulences. Les résultats de
cette revue systématique indiquent qu’une quantité limitée de
données probantes contradictoires soutiennent la recomman-
dation d’une supplémentation en psyllium pour le traitement
des symptômes du SCI.
(Rev can prat rech diétét. 2011;72:48)
(DOI: 10.3148/72.1.2011.48)

Introduction
Irritable bowel syndrome (IBS) is a common gastrointestinal onstrated in IBS patients. Thus the diagnosis of IBS is symptom-
disorder characterized by recurrent abdominal pain, bloating, based and unstandardized. As there is no standardization of di-
distension, cramping, constipation and/or diarrhea, and flatu- agnostic criteria, prevalence estimates vary from 3% to 20% of
lence (1). Diagnosis of IBS can be difficult as no biochemical, the population (2-6). Most estimates, however, suggest a 10% to
structural, or physiological abnormalities are consistently dem- 15% prevalence.

Canadian Journal of Dietetic Practice and Research – Vol 72 No 1, Spring 2011 e107
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Dietary advice is often given for IBS management, and most consideration were identified. Reference lists of relevant articles,
family physicians recommend an increase in total dietary fibre as well as review articles, were hand searched to identify addi-
intake, usually in the form of insoluble fibres such as bran (7). tional publications.
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This is surprising, given the limited evidence for the role of in-
soluble fibre in alleviating IBS symptoms. Insoluble fibre under- Selection criteria and data extraction
goes minimal change in the digestive tract and increases fecal Full-length, English-language primary studies in peer-reviewed
mass. A systematic review of 17 clinical trials of patients with journals were included when psyllium ingestion had been tested
IBS indicated that insoluble fibre not only generally confers no for its effect on IBS symptoms. Study subjects were required to
benefit but, in many cases, may worsen IBS symptoms (8). In have been diagnosed with pre-existing IBS by any criteria, but
contrast, soluble fibre dissolves in water and forms a gel; it is the IBS could not be medication-induced for the purposes of the
fermented by colonic bacteria, forming short-chain fatty acids study. Medication trials were included as long as they contained
and gas, both of which may decrease gut transit time. Shortened analyses of psyllium ingestion effects, independent of the medi-
transit time may alleviate constipation and associated pain. cation. All study designs were considered. All searching and data
Psyllium fibre (also referred to as ispaghula) is derived from the extraction were conducted by the author.
husks of the seeds of Plantago ovata, and is one such soluble fi-
bre (9). Approximately 50% of IBS patients receive some form Study quality
of drug treatment, which often includes psyllium fibre supple- Each study was graded for quality, using the Quality Assessment
mentation (10). Tool for Quantitative Studies developed by the Effective Pub-
While pooled results of studies examining the effectiveness lic Health Practice Project team (17). This tool is used to assess
of soluble fibres (including psyllium) reveal an overall improve- quality of published quantitative studies on the basis of sample
ment in global symptom indices (8), most have severe meth- selection methods, study design, control for confounders, blind-
odological limitations such as inadequate outcome assessment ing, data collection, and withdrawals and dropouts. Studies are
tools or lack of placebo controls. Despite a lack of good quality ranked as weak, moderate, or strong, according to these criteria.
evidence, recommendation of psyllium-based bulk laxatives re-
For personal use only.

Primary outcome measures were also identified, and clinical/

mains quite common and is even indicated for constipation- or statistical significance was noted when possible, as was whether
diarrhea-predominant IBS in the most recent clinical practice intention-to-treat analysis was used.
guidelines for Canadian dietitians (11). Recently, interest has
been renewed in re-examining the role of soluble fibres such RESULTS
as psyllium in a primary care setting (as this is where most IBS Overview of studies identified
patients are treated); this group, specifically, may benefit more The search strategy yielded 144 published articles. Of these, cop-
from fibre therapy than do patients traditionally recruited for ies of 56 full articles were obtained for review, and after scrutiny,
clinical trials (12-14). 12 met the criteria for complete data abstraction. An additional
article was identified through hand search of reference lists and
PURPOSE was eligible for data abstraction. A total of 12 articles met all
While a number of general and systematic reviews have been eligibility criteria and were included in this review. Figure 1 out-
conducted on the role of different types of fibre in IBS symp- lines the study selection process in detail. Quality assessment
toms (8,15,16), none has focused exclusively on the role of psyl- classified one study as “strong” (8%), two as “moderate” (17%),
lium fibre; nor has any review included the more recent studies and nine as “weak” (75%). Many studies classified as weak did
on primary care patients with IBS. In this paper, evidence sup- not describe their blinding, the control of confounders, or the
porting the effectiveness of psyllium fibre supplementation on reliability and/or validity of data-collection tools.
symptoms in diagnosed IBS is evaluated and summarized. No Canadian studies were located. One study was completed
in the United States (18), and the others were conducted in Eu-
METHODS rope and India. Study designs were heterogeneous. Duration of
As much as possible, guidelines for reporting systematic reviews the studies ranged from four to 12 weeks. Study subjects’ char-
of intervention studies were followed (17). acteristics varied considerably; subject age in one study ranged
from 14 to 82 years (19), and sex distribution of the subjects
Search strategy ranged from zero to 90% female. Some articles did not provide
A systematic search of published literature was developed, using demographics for the subjects (18,20,21). Of the 11 studies us-
both free text and/or MeSH terms. The exposure terms searched ing a controlled design (randomized, controlled trial or clinical
were “psyllium,” “ispaghula,” or “Plantago ovata,” combined with controlled trial), four failed to describe the control substance,
“irritable bowel” or “irritable bowel syndrome.” The computer- four failed to report the dose of psyllium that would be tested,
ized databases MEDLINE, CINAHL, and Web of Science were and one failed to report the form of psyllium administered. Of
searched with no limit on publication dates. Searches took place the studies describing the amount of psyllium tested, adminis-
from September 14 to October 7, 2009. Titles and available ab- tered amounts ranged from as little as 7 g per day to as much as
stracts were scanned for relevance, and articles requiring further 30 g per day.

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Figure 1
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Study selection process for systematic review of the effect of psyllium fibre supplementation on
irritable bowel syndrome symptoms

Key terms searched Excluded

n=144 n=88
Review articles 30
Not peer reviewed 10
Subjects not diagnosed
with irritable bowel
syndrome (IBS) 25
Psyllium not tested as a

Articles requiring full treatment 12

Additional studies
identified by hand text review Article not in English 6
review of reference lists n=57 Medication-induced IBS 5
n=1
For personal use only.

Excluded
n=45
Articles meeting criteria No report of effectiveness
for complete data of psyllium independent of
abstraction medication 1
n=12 Not primary sources 2
Duplication 41
Published as abstract only 1

Study outcomes Three of the 12 studies (25%) showed no benefit of psyllium

Table 1 details interventions and outcomes (14,18,19-28). In nine administration for any outcomes measured (18,25,29). In six of
(75%) studies, patient-perceived symptom improvement was the nine studies measuring a global symptom outcome, patient-
measured (14,19-23,26-28), while in two (17%), quality-of-life perceived global symptoms improved significantly (p<0.05) with
outcomes were examined (14,18). In six (50%), improvements in psyllium ingestion (14,19,20,22,23,26). One study indicated sig-
specific symptoms such as abdominal pain, gas, or bowel actions nificant improvements in reported abdominal pain (24), while
were investigated (14,18,24,25,28). In several studies, objective three did not (14,18,22). Quality of life and flatulence symptoms
measures were used alone or in combination with the measures did not improve in any of the studies in which those outcomes
above. Physician assessment was performed in one study (8%) were examined specifically. Bowel movement characteristics and
(24), gut transit time was measured in two studies (17%)(21,22), subjective bowel function improved significantly in three studies
and stool weight was measured in one (8%)(21). (25%) and not in one (8%)(18). Gut transit time was not im-
Numbers of subjects completing the studies ranged from 10 proved significantly in either study in which it was measured. Of
to 168 over the 12 studies. The mean number of subjects per the studies classified as being of “strong” or “moderate” quality
study was 82.3. (n=3), two described significant improvements in well-being or

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Table 1
Summary of studies on irritable bowel syndrome and psyllium fibre included in the literature review
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Design
(quality Participants and
Study assessment) intervention Results Comments
Arthurs and Fielding, Randomized, Target: patients newly diagnosed with No significant difference Subjects were 61 females,
1983, Ireland (27) controlled trial irritable bowel syndrome (IBS) between groups; p values not 17 males, aged 15-50 years
(weak) described
Intervention: ispaghula/poloxamer
granules, dose not specified Subjects completing study:
78
Control: not specified
Duration: 4 weeks
Outcome measures: Patient report
of general symptoms as either mild,
moderate, or severe
Bijkerk et al., 2009, Randomized, Target: patients aged 18-65 years Significant improvement in Subjects were 94% white,
Netherlands (14) controlled trial diagnosed with IBS in last 2 years adequate symptom relief 78% female, mean age 34.4
(strong) with psyllium in 1st and 2nd years
Intervention: 10 g psyllium (form not month only (p<0.05); severity
identified) BID of symptoms was significantly Used intention-to-treat (ITT)
decreased (p<0.05); no change analyses
Control: bran or rice flour
in quality of life or abdominal
Duration: 12 weeks pain
Outcome measures: patient- Subjects completing study:
determined adequate symptom relief 164
(primary), quality of life, severity of
symptoms, abdominal pain (secondary)
Chapman et al., 1990, Controlled clinical Target: patients aged 18-75 years with No difference between Parallel group study, subjects
For personal use only.

England (25) trial (weak) IBS groups (p=0.499); both treated with ispaghula +
groups improved significantly mebeverine or dietary advice
Intervention: ispaghula 3.5 g BID (p<0.001) + mebeverine
Control: high-fibre dietary advice Subjects completing study: Open study due to nature of
Duration: 8 weeks 103 control
Outcome measures: number and Unpalatability of ispaghula
severity of pain attacks, number of bowel described by many subjects
actions with stool consistency Subjects were aged 18-74
years; 76% female
Dettmar and Sykes, Controlled clinical Target: patients with IBS >1 year duration Significant reduction in Parallel group study, similar to
1999, United Kingdom trial (weak) physician-assessed abdominal Chapman et al.’s design (25);
(24) Intervention: ispaghula husk 3.5 g pain (p<0.01), as well as open study due to nature of
BID-TID physician-assessed (p<0.01) control
Control: high-fibre dietary advice and patient-assessed (p<0.05)
bowel function Subjects were 71% female;
Duration: 4 weeks ages ranged from 18-40
Subjects completing study: years; mean age 34 years
Outcome measures: physician and 110
patient assessments of number and
severity of episodes of pain and bowel
function
Golechha et al., 1982, Randomized, Target: IBS patients 13/26 reported improvement No description of data
India (20) controlled trial— with ispaghula versus 6/26 collection or assessment tools;
placebo- controlled Intervention: ispaghula husk powder, with placebo (p<0.05) no demographic information
crossover design no dose specified available
(weak) Subjects completing study:
Control: wheat flour 26
Duration: 3 weeks for each intervention,
6 weeks total
Outcome measures: patient-described
overall symptom improvement
Jalihal and Kurian, Controlled clinical Target: IBS >2 years Significant improvement in Subjects: 16 male, 4 female;
1990, India (22) trial— placebo- satisfaction with BMs with age range 17-56 years;
controlled crossover Intervention: 30 g ispaghula husk OD ispaghula (p<0.05); no change median age 38 years
design (weak) Control: not specified in pain, flatulence, number of
BMs, consistency of BMs, gut
Duration: 4 weeks treatment, 4 weeks transit time (p>0.05)
alternate therapy
Subjects completing study:
Outcome measures: patient reports 20
of pain, flatulence, number of bowel
movements (BMs), average consistency
of BMs, satisfaction with BMs, %
symptom improvement, gut transit time

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Table 1 (cont’d.)
Summary of studies on irritable bowel syndrome and psyllium fibre included in the literature review
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Design
(quality Participants and
Study assessment) intervention Results Comments

Kumar et al., 1987, Cohort (weak) Target: male patients with IBS Significant improvement in Study trying to determine
India (21) symptom score (p<0.01); optimum dosage of ispaghula
Intervention: processed ispaghula husk, significant increase in stool
10 g/20 g/30 g a day for each of 17 days weight (p<0.001) with best Subjects all male; no age
results at 20 g; no change to information provided
Control: N/A
transit time (p>0.05)
Duration: 51 days
Subjects completing study:
Outcome measures: patient reports of 10
symptoms, gut transit time by radio-
opaque markers, stool weight
Longstreth et al., Randomized, Target: Patients >18 years with IBS No significant improvement No descriptive statistics of
1981, United States controlled trial with intervention (p>0.05); study subjects
(18) (moderate) Intervention: Metamucil 6.4 g TID significant improvement with
Control: cornstarch, dextrose, and control substance
polyvinylpyrrolidone Subjects completing study:
Duration: 8 weeks 60
Outcome measures: stool consistency,
abdominal pain, gas, interference of
symptoms with activities of daily living
Nigam et al., 1984, Controlled clinical Target: IBS patients aged 16-68 years Significant improvement in No description of data
India (23) trial (weak) patient-described symptoms collection or assessment tools
Intervention: ispaghula husk, dose not
For personal use only.

with ispaghula (p<0.02)

specified Subjects: 55% male; average
Subjects completing study: age 34.5 years
Control: not specified 168
Duration: 12 weeks
Outcome measures: patient-described
overall symptom improvement
Prior and Whorwell, Randomized, Target: patients with IBS, aged 18-63 Significant decrease in number Subjects were 90% female
1987, England (28) controlled trial years of days with no BM (p=0.026);
(moderate) significant increase in reported Used ITT analysis
Intervention: ispaghula husk (Regulan) well-being (p=0.02); significant
3.6 g TID, with patient discretion to decrease in transit time
change dose as desired (p=0.001); no difference in
Control: Regulan with no ispaghula pain, bloating, days with >3
BMs (p>0.05)
Duration: 12 weeks
Subjects completing study:
Outcome measures: patient report of 57
improvement in well-being; days with no
or >3 BMs; pain, bloating, measured gut
transit time
Ritchie and Truelove, Randomized, Target: not described 23/48 reported improvement Factorial design, along with
1979, England (26) controlled trial with ispaghula versus 13/48 lorazepam (Ativan) and
(weak) Intervention: ispaghula husk (Fybogel); with placebo (p>0.05) butylscopolamine (Buscopan)
no dose described
Subjects completing study: Authors describe likely
Control: not described 96 synergy between treatments
Duration: 12 weeks No description of data
Outcome measures: patient-described collection or assessment tools
overall symptom improvement Subjects: mean age 38 years;
range 16-69 years; 77%
female

Ritchie and Truelove, Randomized, Target: not described 33/48 patients reported Factorial design, along
1980, England (19) controlled trial improvement with ispagula vs. with muscle relaxants and
(weak) Intervention: ispaghula husk (Fybogel) 23/48 with bran (p<0.05) psychotropic drugs
3.5 g BID
Subjects completing study: Authors describe likely
Control: coarse natural bran 96 synergy between treatments
Duration: 12 weeks No description of data
Outcome measures: patient-described collection or assessment tools
overall symptom improvement Subjects: mean age 39 years;
range 14-82 years; 74%
female

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overall symptom relief with psyllium administration (14,28), while IBS. Negative impacts of IBS on quality of life have been report-
one showed no significant improvement in any symptoms, but ed in numerous studies (33-36). Further, research teams in the
rather an advantage with the control substance over psyllium (18). United Kingdom and the United States have recently demon-
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strated financial and social impacts of IBS. Lost productivity is

DISCUSSION often noted, and an employee with IBS is estimated to cost the
The results of this systematic review indicate limited and con- employer six hours of lost productivity each week (36), which is
flicting evidence exists to support the recommendation of psyl- 50% more than an employee without IBS costs employers (37).
lium supplementation for symptomatic IBS treatment. The het- When exploring these secondary outcomes in treatment
erogeneity of the 12 studies included in this review precluded the trials, investigators should employ disease-specific quality-of-
collation of results as a meta-analysis. Psyllium fibre supplemen- life instruments (31), such the Work Productivity and Activity
tation may be effective for patient-reported global symptom re- Impairment questionnaire, which was developed and validated
lief and constipation-related symptoms, but does not appear to specifically for use in IBS-affected individuals (37). As with the
be effective for abdominal pain, flatulence, or patient-reported primary outcome measures outlined above, these validated sec-
quality-of-life measures. ondary outcome measures were not available when many of the
studies in this review were published.
Variable outcome measurements
Outcomes measured in the 12 studies varied considerably, with Study design, outcomes, and duration
most employing a general patient report of overall symptom Study design and reporting of methods were quite variable
improvement, and secondary outcomes of reported or mea- among the studies reviewed. While a number of randomized
sured improvement in specific IBS-related symptoms. While and clinical controlled trials were included, many did not de-
these measures may have face validity, many have not been scribe the method of randomization or whether blinding was
tested in the IBS population. Moreover, a recent meta-analysis used. While the double-blind, randomized, placebo-controlled
indicates that the outcome measure of “global improvement in trial is now considered the gold standard in IBS treatment tri-
For personal use only.

IBS symptoms,” employed by the majority of studies in this re- als (31), blinding may be difficult in trials including dietary in-
view, is associated with a greater placebo response rate than is terventions. When a placebo is chosen, it must be one believed
measured improvement in individual symptoms (29). This may to lack any specific effect that would change the outcome being
in part explain the inability to detect significant difference be- measured. In some studies, bran or wheat flour was used as a
tween treatment groups for this outcome in some of the studies control substance, which may not be appropriate as increased
reviewed. A number of the studies were classified as “weak” in insoluble fibre may worsen IBS symptoms in some patients (8).
quality partly because of the lack of evidence for reliability and/ Factorial designs were employed in three of the 12 studies
or validity of the outcome measures used. reviewed (19,25,26). These studies were considered appropriate
for inclusion in this review because all treatments had distinct
Adequate relief mechanisms of action and treatments were assigned so that
Before 1998, no accepted or widely used measures were avail- simple effects of each treatment, as well as possible synergies be-
able for outcome assessment in IBS treatment trials. In 1998, tween treatments, could be detected (31).
the measure of “adequate relief” was validated as a clinically Sample size was variable (10 to 168 subjects) among stud-
meaningful outcome measure. “Adequate relief” is defined as a ies, and methods for determining sample size were not routinely
patient’s report of adequate relief of abdominal pain and dis- outlined. Smaller sample sizes have less power than larger ones
comfort (30). Patients are considered responders to treatment to reveal significant outcomes, and can result in type II statistical
if they report adequate relief during at least 50% of the weeks error (38). For clinical trials with multiple outcome measures,
of the treatment trial. The Design of Treatment Trials Commit- a sample size that can provide at least 90% power for each end
tee (DTTC) of the American Gastroenterological Association point should be employed (39).
has since endorsed this outcome (31). Physician assessment of Intention-to-treat analysis was used in only two of the 12
symptom improvement was employed as an outcome measure studies. This type of analysis is now considered the standard for
in one study (24), but has since been associated with greater the transparent reporting of clinical trial results (40), and it is
measurement error than is patient report (32). The DTTC now recommended for use in IBS treatment trials specifically (31).
exclusively endorses the use of patient-reported measures (31). As with study design and outcome measures, study duration
and psyllium doses were variable. Psyllium doses ranged from 7
Quality of life g a day to as much as 30 g a day in the seven studies detailing the
Quality-of-life assessments are considered important outcome dose. In only one small study (n=10) did the investigators at-
measures but should be secondary to patient-reported physical tempt to determine the optimal dose of psyllium effective in im-
symptom outcomes because they are considered more respon- proving symptoms and increasing stool weight. They concluded
sive to treatment (31). While not as easily measured in the set- that 20 g of psyllium a day is likely the preferred dose (21). The
ting of a treatment trial, quality-of-life assessments are likely to remaining study groups that outlined intervention doses did not
be clinically relevant and important to individuals living with publish the justifications for the dose chosen. This is a signifi-

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cant oversight, as suboptimal doses may lead to underestimated RELEVANCE TO PRACTICE
treatment effects and inflated doses may be detrimental. Currently, the therapeutic norm is a recommendation of psylli-
Study duration ranged from four to 12 weeks. While all 12
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um fibre supplementation in IBS patients’ diets (11), but this re-

studies lasted longer than the four weeks Bijkerk et al. determined view has shown only limited support for this recommendation.
to be the minimum required to show benefit, not all lasted long The British Society of Gastroenterology (42) clinical practice
enough to detect the absence of benefit after eight weeks, which guidelines acknowledge the limited availability of high-quality
these authors also noted (14). Further, some of the longer stud- research on the effects of psyllium fibre, especially in primary
ies tested effects only at baseline and 12 weeks, potentially miss- care settings. The society advises that, if fibre supplementation
ing the key time frame for the most significant improvements is needed, it should be in the form of soluble (as opposed to
in symptoms outlined in Bijkerk et al. (14). Moreover, if the insoluble) fibres such as psyllium fibre. Similarly, Dietitians of
most significant improvement in IBS symptoms continues to be Canada practice guidelines indicate that, because of inconsis-
found in the first two months of treatment, the next step should tent results and poorly designed studies, evidence is controver-
be proposing mechanisms for this time-dependent response, as sial for fibre supplementation in those with IBS (44). Psyllium
well as further treatment options for practitioners dealing with fibre may provide modest global symptom relief, especially in
IBS patients no longer responding to psyllium therapy. constipation-predominant IBS; however, clinicians may wish to
Broad study populations and rigorous sampling procedures exercise caution when recommending supplementation, as the
increase external validity of clinical trials and support the gener- evidence for the effectiveness of psyllium fibre remains limited
alizability of findings to patients outside the trial. While the ma- and conflicting.
jority of patients receive IBS management in primary care (41),
only one study group (14) in the current review examined this References
population. Generalizing the results of the remaining studies to 1. M axton DG, Morris JA, Whorwell PJ. Ranking of symptoms by patients with
patients seeking primary care is therefore difficult, and drawing the irritable bowel syndrome. BMJ. 1989;299:1138.
conclusions about the impacts on IBS sufferers who do not seek 2. Hahn BA, Saunders WB, Maier WC. Differences between individuals with
medical attention is even more challenging. Of note is the wide self-reported irritable bowel syndrome (IBS) and IBS-like symptoms. Dig
For personal use only.

Dis Sci.1997;42:2585-90.
demographic variability of study participants included in this 3. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al.
review. Although female IBS sufferers predominate in the gen- U.S. householder survey of functional gastrointestinal disorders. Prevalence,
eral population (42), female subjects represented between zero sociodemography, and health impact. Dig Dis Sci. 1993;38:1569-80.
to 90% of the sample in the studies reviewed. 4. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of
colonic symptoms and the irritable bowel syndrome. Gastroenterology.
1991;101:927-34.
Therapeutic acceptability and tolerance 5. Saito YA, Locke GR, Talley NJ, Zinsmeister AR, Fett SL, Melton LJ 3rd. A
Poor acceptability and tolerance of psyllium therapy were re- comparison of the Rome and Manning criteria for case identification in epi-
ported to be a significant issue in only one study (25). Interest- demiological investigations of irritable bowel syndrome. Am J Gastroenterol.
ingly, this study employed the smallest dose of psyllium, only 2000;95:2816-24.
3.5 g twice a day. This is in contrast to a more recent lipid study 6. Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastro-
intestinal disorders in Canada: first population-based survey using Rome
employing a similar dose of psyllium, in which no difference was II criteria with suggestions for improving the questionnaire. Dig Dis Sci.
found between the acceptability of psyllium and placebo (43). 2002;47:225-35.
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