Low Dose Mesalazine Plus Bismuth Regimen and Symptoms of Irritable Bowel Syndrome in Patients with Bloating: A Quasi-Experimental Study

Abstract

Background: The current study aimed to evaluate the efficacy of mesalazine plus bismuth on patients with irritable bowel syndrome (IBS) and chief complaint of bloating. Methods: The current quasi-experimental study, included patients with IBS and chief complaint of bloating and incomplete defecation. They were treated with masalazine and bismuth subcitrate and followed regularly based on monthly visits. The rate of symptoms relief, patients' satisfaction and any side effects were recorded during the surveillance. Results: Overall, 42 patients (33 females and 9 males) were included. The mean age of the patients was 35.9 years (ranged 22 - 67 years); 32%, 44% and 24% had high, medium and low socioeconomic levels, respectively; 96% of the patients were nonsmokers and just two patients had a history of alcohol consumption. Two patients had glucose intolerance, four had hypothyroidism and four had past history of valvular heart disease. In 20% of the patients, the family history for intestinal bowl disease (IBD) was positive. Ten patients had a history of bloody diarrhea and no one had a history of any significant liver diseases. The most common symptoms of patients included incomplete defecation and tenesmus (41 patients, 97.6%), bloating (39 patients, 92.8%), abdominal fullness (35 patients, 83.3%) and mucus discharge (30 patients, 71.4%). After an average six months of treatment (3 - 11 months), 69.1% of patients reported improvement of symptoms more than 50% (38.1%, ranged 75% - 100%), and 31% (ranged 50% - 75%) indicated overall symptoms relief). The most significant improvement was reported for bloating (85%). There were no major side effects except minor degrees of diarrhea among 26% of the subjects. Conclusions: The results of the study were indicative of improvement and symptom relief in the majority of patients and it seems that treatment prolongation up to six months could be a key factor to achieve better clinical responses. It is recommended that further randomized clinical trials evaluate this therapeutic regimen.