How strong is the evidence for the use of perioperative β blockers in non-cardiac surgery? Systematic review and meta-analysis of randomised controlled trials
Authors: P J Devereaux, W Scott Beattie, Peter T-L Choi, Neal H Badner, Gordon H Guyatt, Juan C Villar, Claudio S Cinà, Kate Leslie, Michael J Jacka, Victor M Montori, Mohit Bhandari, Alvaro Avezum, Alexandre B Cavalcanti, Julian W Giles, Thomas Schricker, Homer Yang, Carl-Johan Jakobsen, Salim Yusuf
Journal: BMJ (2005)

<h3>Introduction</h3> Little is published on the health impact of irritable bowel syndrome with diarrhoea (IBS-D) on patients. We aimed to assess the gastrointestinal and wider health burden of IBS-D, including medications used for symptom relief and perceived care shortfalls. <h3>Method</h3> A 30 min online survey was completed in France, Germany, Italy, Spain, UK, Canada and Australia. Target sample size was 80 patients per country. Screening criteria included: age 18–65 years, being diagnosed with IBS-D by a doctor, having symptoms present within the past 12 months, and currently using prescription or over-the-counter (OTC) medicines for IBS-D. The maximum quota was 30% male and 25% of patients who had never seen a gastroenterologist for their IBS. Attitudes to IBS-D and its management were scored using a 7-point scale (Table). <h3>Results</h3> 513 eligible patients completed the survey; 357 (70%) were female and mean age was 40.9 (range 18–65) years. As well as stomach pain and diarrhoea, 269 (52%) patients had bloating before treatment, 204 (40%) had urgency and 88 (17%) had faecal incontinence. Mean duration of symptoms was 9.8 years. The most troublesome current symptom was urgency in 136 (27%) patients. In the past 3 months, symptoms were intermittent in 390 (76%) patients and continual in 123 (24%). The most common comorbidities were anxiety in 189 (37%) patients, depression in 137 (27%) and migraine in 133 (26%). OTC drugs were used by 372 (73%) patients (214 [42%] OTC only, 158 [31%] OTC + prescription). The most commonly used agents were antidiarrhoeals in 416 (81%) patients and antispasmodics in 300 (58%); notably, 91 (18%) used codeine-based painkillers and 79 (15%) used antidepressants. Antidiarrhoeals were used daily by 63 (12%) patients and 58 (11%) used daily antispasmodics; 178/384 (46%) and 99/217 (46%) were not satisfied with these agents. Patients had mixed attitudes towards their condition (Table: score 6–7): 216 (42%) reported having learned to live with their IBS but 189 (37%) were constantly worried about when their symptoms would return, and 58 (11%) agreed with the statement "When my IBS is bad, I wish I was dead". A substantial proportion (170; 33%) wanted doctors to listen and support more and 165 (32%) agreed that healthcare professionals do not take IBS seriously. The majority of patients (296; 58%) wanted treatment to significantly improve their quality of life and 237 (46%) were willing to try anything to help manage their IBS. <h3>Conclusion</h3> We report the substantial impact of IBS-D on quality of life, medication use and the desire for more services in this patient population. There is a distinct opportunity for improved pharmacological and supportive management of IBS-D patients. <h3>Disclosure of Interest</h3> H. Törnblom Conflict with: Almirall, Allergan and Shire, Conflict with: Shire, Almirall, Probi, Tillotts, A Emmanuel Conflict with: Allergan, Kyowa Kirin, Shionogi, Shire, Takeda, R Goosey Conflict with: Kantar Health, paid consultants to Allergan plc, G Wiseman Conflict with: Allergan plc, S Baker Conflict with: Allergan plc