Prescrire international
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Prescrire international · Apr 2009
Irritable bowel syndrome: a mild disorder; purely symptomatic treatment.
(1) Patients frequently complain of occasional bowel movement disorders, associated with abdominal pain or discomfort, but they are rarely due to an underlying organ involvement. Even when patients have recurrent symptoms, serious disorders are no more frequent in these patients than in the general population, unless other manifestations, anaemia, or an inflammatory syndrome is also present; (2) There is currently no way of radically modifying the natural course of recurrent irritable bowel syndrome; (3) The effects of antispasmodics on abdominal pain have been tested in about 20 randomised controlled trials. Pinaverium and peppermint essential oil have the best-documented efficacy and only moderate adverse effects. ⋯ A few cases of septicaemia have been reported; (11) The six available trials of acupuncture (versus sham acupuncture) showed no more than a placebo effect; (12) In practice, patients who have recurrent irritable bowel syndrome but with no other signs of a condition warranting specific treatment should be reassured as to the harmless nature of their disorder if a careful physical examination and basic laboratory tests are negative. The only available treatments have purely symptomatic effects and only limited efficacy. It is best to avoid using all treatments and additional diagnostic investigations that carry a risk of disproportionate adverse effects.
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In a trial involving patients with advanced-stage liver cancer but unimpaired hepatic function, sorafenib increased the median survival time by about 3 months in half of patients, but provoked frequent adverse effects.
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Prescrire international · Feb 2009
Sitagliptin combined with sulphonylureas: new indication. Other treatments are preferable.
In type 2 diabetes, sitagliptin, in combination with a sulphonylurea, only provides modest efficacy in terms of HbA1c levels and increases the risk of hypoglycaemia.