Systematic review: serotonergic modulators in the treatment of irritable bowel syndrome--influence on psychiatric and gastrointestinal symptoms.
BACKGROUND
Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.


OBJECTIVE
To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.


METHODS
A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points).


RESULTS
Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.


CONCLUSIONS
The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.
Kilkens
T O C
TO
Department of Psychiatry, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Honig
A
A
Rozendaal
N
N
Van Nieuwenhoven
M A
MA
Brummer
R-J M
RJ
D003109:Colonic Diseases, Functional / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome
D012702:Serotonin Antagonists