Bran and irritable bowel syndrome: The primary-care perspective

Background. We have shown that bran exacerbates irritable bowel syndrome symptoms in a large proportion of secondary-care patients. However, it is unknown if this also happens in primary-care or whether a better response to bran occurs, leading to bran failures being selected for referral to the specialist. Aims. To assess the response to bran in primary-care irritable bowel syndrome comparing it to that obtained in secondary-care. Patients and methods. One hundred consecutive primary-care irritable bowel syndrome patients were asked how bran or soluble fibre products affected their symptoms. Results. Bran improved symptoms in 27% of primary-care and 10% of secondary-care patients (p < 0.01) and exacerbated symptoms in 22% of primary-care and 55% of secondary-care patients (p < 0.001). Fifty-one percent of primary-care and 33% of secondary-care patients reported no change with bran. In primary-care, proprietary fibre led to improvement in 25%, deterioration in 19% and no change in 56% which was not significantly different to secondary-care. Conclusion. Although not especially effective in primary-care irritable bowel syndrome patients, bran does Dot cause so many problems and is more helpful than in secondary-care. The effects of soluble fibre are similar in both primary-care and secondary-care. This study highlights the problem of extrapolating the response to treatment in irritable bowel syndrome from different care settings. (c) 2006 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.