The Efficacy Of Amitriptyline In The Treatment Of Irritable Bowel Syndrome:A Meta Analysis

AIM: We aimed to study the efficacy of amitriptyline as a treatment method for irritable bowel syndrome(IBS),especially for IBS with predominant diarrhea(IBS-D).METHODS:The databases including the Cochrane Central Register of Controlled Trials 、 EMBASE 、 Pubmed 、 CNKI 、 CBM were searched for randomized placebo-controlled trials studing the efficacy and safety of amitriptyline in treating IBS.We included and excluded articles by several approaches including reading abstract or full-text.Observation target: the symptom relief,the occurrence of side effect.We also carried out a subgroup analysis based on dosage.The Revman 5.2software was used for assessment.We used χ~2 test to explore the heterogeneity of the effect estimates.A fixed-model was used for this meta-analysis hence the articles included were homogeneity.The total effect was defined by all articles themselves(including improvement of at least 2 main symptoms).Thus the effect was calculated by dichotomous variable,relative risk(RR)and confidence interval(CI)were used for the assessment.Funnel plots were used as an indicator of publication bias.RESULTS: Five placebo-controlled randomized trials including 256 patients were involved in this analysis.Amitriptyline(68.75%)were significantly with higher global symptom relief [RR=1.73,95%CI=(1.36,2.19),p < 0.05] compared to the placebo(39.84%)for IBS.As for IBS-D,amitriptyline(72.63%)were significantly with higher global symptom relief [RR=1.60,95CI%(1.25,2.07),p <0.05] compared to the placebo(45.26%).We also carried out a subgroup analysis based on dosage.The difference of the symptom relief between low dosage amitriptyline(70.17%)and high dosage amitriptyline(≥50mg)(69.01%)were not significance[RR=1.75,95%CI=(1.37,2.22),p >0.05].Subgroup analysis based on dosage in side effect were carried.Of which indicated that high-dose amitriptyline’s side effect(23.68%)weren’t makes difference compared to low-dose amtriptline’(36.84%),RR=0.75,95%CI(0.52,1.09),p >0.05.Between treatment and placebo groups,the difference of side effects wasn ’t significance [RR=0.83,95%CI =(0.51,1.36),p >0.05].CONCLUSION: Amitriptyline might be effective and safe for patients suffering from IBS,especially for IBS-D.Subgroup analysis indicated that high-dose amitriptyline obtain satisfactory effect.And the placebo effect for IBS patients obtain significance.In terms of the shortage of studies,further RCTs ought to be taken to guide the treatment and efficacy and so on.