Amitriptyline: A Potentially Effective Option for Irritable Bowel Syndrome in Primary Care

Most patients with irritable bowel syndrome (IBS) are managed by generalists. IBS has no definitive cure, and first-line treatments — such as dietary and lifestyle changes, soluble fiber, laxatives, and antispasmodic or antidiarrheal medications — often yield only modest benefits. Among many potential second-line pharmacologic therapies, tricyclic antidepressants (e.g., amitriptyline) have proven at least somewhat effective and commonly are prescribed by generalists for other indications. But these agents have not been assessed in a randomized trial for IBS in a primary care setting.

Investigators recruited 460 patients with IBS that was refractory to first-line therapies from 55 English general practices and randomized them to receive low-d…