Does amitriptyline help for irritable bowel syndrome pain management?: An updated systematic review and meta-analysis

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders (FGIDs) worldwide. Amitriptyline is commonly prescribed for managing the symptoms of IBS as a second-line treatment. This study aimed to consolidate the existing evidence on the pain therapeutic efficacy of amitriptyline in adults with IBS.

Following the PRISMA guidelines, we conducted an updated systematic review and meta-analysis of observational studies and randomized controlled trials, searching 4 databases (PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) from inception until March 15, 2024.

The study included 15 studies involving 1497 patients with IBS, 12 of which were included in the meta-analysis. The main pooled rate of improvement significantly in amitriptyline was 66.61% (95% CI: 61.69-71.53%, fixed model); (P = .31; I2 = 5%). The pooled odd ratio was statistically significant in amitriptyline over the placebo 2.07 (95% CI: 1.48-2.91, fixed model); (P = .40; I2 = 1%). The findings conclude that amitriptyline is an effective treatment, precisely for improving IBS pain-related management.

Amitriptyline significantly confers short-term improvements in abdominal pain and global IBS symptoms, but the certainty of evidence is limited by generally short follow-up, variable study quality, and incomplete reporting of safety and withdrawals. Longer, well-designed trials with standardized outcomes and systematic adverse-event monitoring are needed to clarify long-term effectiveness and tolerability.