Anti-irritable Bowel Syndrome Syrup Improves Constipation-Predominant Irritable Bowel Syndrome:A Randomized,Placebo-Controlled Trial

Objective To evaluate the efficacy and safety of administration of the formulated Persian herbal syrup on improving the symptoms of patients with constipation-predominant irritable bowel syndrome(IBS-C).Methods This study was conducted in 70 patients with IBS-C,who were recruited from 3 medical centers in Mashhad,Iran,from November 2017 to August 2018.Seventy patients were randomly assigned to 2 groups including treatment and placebo groups by block randomization,35 cases in each group.Patients in the treatment group received 15 mL of anti-IBS syrup,thrice daily for 6 weeks and followed up for 4 weeks.Placebo syrup was also prepared through similar instruction,BP syrup without plant extract was used.Primary outcome induding IBS Symptom Severity Scale(IBS-SSS)questionnaire and secondary outcomes in terms of Hospital Anxiety and Depression(HADS)questionnaires,the Bristol Stool Form Scale(BSFS)were completed and evaluated at weeks 6 and 10,respectively.Safety indices were collected at the end of the treatment and Common Terminology Criteria for Adverse Events v4.0(CTCAE)was used to evaluate the adverse events.Results The response to treatment was 84.4%(27/32)in the treatment group and 46.4%(13/28)in the placebo group,respectively(P=0.002).Compared with pre-treatment,a significant decrease was found on the IBS-SSS and BSFS scores after 6-week intervention in both groups(P<0.001).Moreover,IBS-SSS and BSFS scores in the treatment group were lower than the placebo group after the intervention(P=0.041).There was no significant difference in the anxiety and depression scores after treatment in both groups(P>0.05).Side effects reported in the treatment group included 2 cases of headache during the first week of the onset of the treatment,1 case of drowsiness,1 case of increase in menstrual bleeding,which did not result in discontinuation of the treatment.In the placebo group,1 case of exacerbation of the disease was reported.Conclusions Anti-IBS syrup significantly reduced the severity of IBS symptoms compared to placebo.However,there was a need for further investigation regarding the anxiety and depression scores.(Registration No.IRCT2017061034446N1).