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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.