Randomised controlled trials (RCTs) that compared TCAs with placebo in the management of patients with IBS were eligible for inclusion. Outcomes of interest were global improvement of symptoms and adequate relief of pain and discomfort.
TCAs evaluated included amitriptyline, imipramine, desipramine, doxepin and trimipramine. Duration of treatment/follow-up was varied and ranged from four to 12 weeks. Doses of TCAs were varied: initial doses ranged from 10mg to 75mg; and subsequent doses ranged from 50mg to 150mg. Patients in the included studies had diarrhea predominant-IBS (D-IBS), constipation predominant-IBS (C-IBS) and alternating-IBS (Alt-IBS). Approximately half of the patients were female. Mean age, where reported, ranged from 32.5 to 45.2 years. Definitions of clinical response were varied.
Three reviewers independently screened studies for inclusion. Disagreements were assessed through consensus discussion.