Clinical Question: Can a self-help guidebook help patients with irritable bowel syndrome (IBS)?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (nonblinded)

Allocation: Concealed

Synopsis: Adults (n = 420) diagnosed with IBS by their primary care physician or a gastroenterologist were enrolled in a self-help study. The primary intervention was a guidebook with information about lifestyle, diet, medications, and alternative therapies. Patients were randomly assigned (allocation concealed) to one of three groups: self-help guidebook alone; the same guidebook plus a group meeting; or usual care. Groups were balanced at the start of the study, and analysis was by intention to treat. The patients’ mean age was 40 years, 89 percent were women, and they had experienced bowel symptoms for a mean of six years. Patients receiving the guidebook made fewer visits to their primary care physician than did patients in the usual care group (1.6 fewer visits after one year). The group meeting conferred no additional benefit over the guidebook alone. Symptoms improved in all three groups, although the greatest improvement occurred in patients receiving the guidebook (0.5 additional points on a 7-point scale, which is of unlikely clinical significance).

Bottom Line: A self-help guidebook can reduce primary care visits among patients with IBS, although symptoms are only minimally improved. (Level of Evidence: 1b)