title: Bran and irritable bowel syndrome: the primary-care perspective.
abstract: BACKGROUND
  We have shown that bran exacerbates irritable bowel syndrome symptoms in a large proportion of secondary-care patients. However, it is unknown if this also happens in primary-care or whether a better response to bran occurs, leading to bran failures being selected for referral to the specialist.
  
  
  OBJECTIVE
  To assess the response to bran in primary-care irritable bowel syndrome comparing it to that obtained in secondary-care.
  
  
  METHODS
  One hundred consecutive primary-care irritable bowel syndrome patients were asked how bran or soluble fibre products affected their symptoms.
  
  
  RESULTS
  Bran improved symptoms in 27% of primary-care and 10% of secondary-care patients (p<0.01) and exacerbated symptoms in 22% of primary-care and 55% of secondary-care patients (p<0.001). Fifty-one percent of primary-care and 33% of secondary-care patients reported no change with bran. In primary-care, proprietary fibre led to improvement in 25%, deterioration in 19% and no change in 56% which was not significantly different to secondary-care.
  
  
  CONCLUSIONS
  Although not especially effective in primary-care irritable bowel syndrome patients, bran does not cause so many problems and is more helpful than in secondary-care. The effects of soluble fibre are similar in both primary-care and secondary-care. This study highlights the problem of extrapolating the response to treatment in irritable bowel syndrome from different care settings.
authors.affiliation: South Manchester University Hospitals, Manchester, UK.
authors.forename: V
authors.initials: V
authors.lastname: Miller
authors.forename: R
authors.initials: R
authors.lastname: Lea
authors.forename: A
authors.initials: A
authors.lastname: Agrawal
authors.forename: P J
authors.initials: PJ
authors.lastname: Whorwell
mesh_terms: D000328:Adult; D000368:Aged; D004043:Dietary Fiber / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016896:Treatment Outcome