Fiber supplementation in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials.
Emergingsuggested applicable standard· American Gastroenterological Association-American College of Gastroenterology (AGA-ACG), 'American Gastroenterological Association-American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation' (Chang L, et al., Gastroenterology 2023;164(7):1086-1106), 2023
Decision at stakewhether fiber supplementation (and specifically psyllium) is effective for constipation-related symptoms in IBS-C
… The guideline attaches several qualifiers that must not be dropped: (1) among the fiber supplements the panel evaluated, psyllium (3 trials), bran (1 trial), inulin (2 trials), methylcellulose (no trials found), only psyllium appears to be effective, with 'very limited and uncertain' data on bran and inulin and no evidence base at all for methylcellulose; (2) there is no clear evidence that soluble or insoluble fiber is more effective for constipation specifically; (3) on implementation, 'fiber supplements can be used as first-line therapy for CIC, particularly for individuals with low dietary fiber intake,' and 'dietary assessment is important to determine total fiber intake from diet and supplements'; (4) 'a trial of fiber supplement can be considered for mild constipation before PEG use or in combination with PEG'; (5) the total daily fiber target cited by the guideline is 20-30 g/day from diet plus supplement, derived from the Academy of Nutrition and Dietetics figure of 14 g per 1,000 kcal; (6) flatulence is a commonly observed side effect and adequate hydration should be encouraged. …
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
In adults with chronic idiopathic constipation, the AGA-ACG panel suggests the use of fiber supplementation over management without fiber supplementation. This is a CONDITIONAL recommendation based on LOW certainty of evidence. The guideline attaches several qualifiers that must not be dropped: (1) among the fiber supplements the panel evaluated, psyllium (3 trials), bran (1 trial), inulin (2 trials), methylcellulose (no trials found), only psyllium appears to be effective, with 'very limited and uncertain' data on bran and inulin and no evidence base at all for methylcellulose; (2) there is no clear evidence that soluble or insoluble fiber is more effective for constipation specifically; (3) on implementation, 'fiber supplements can be used as first-line therapy for CIC, particularly for individuals with low dietary fiber intake,' and 'dietary assessment is important to determine total fiber intake from diet and supplements'; (4) 'a trial of fiber supplement can be considered for mild constipation before PEG use or in combination with PEG'; (5) the total daily fiber target cited by the guideline is 20-30 g/day from diet plus supplement, derived from the Academy of Nutrition and Dietetics figure of 14 g per 1,000 kcal; (6) flatulence is a commonly observed side effect and adequate hydration should be encouraged. Fiber's placement within the guideline's own hierarchy is itself part of the recommendation: polyethylene glycol, bisacodyl, sodium picosulfate, linaclotide, plecanatide and prucalopride carry STRONG recommendations, whereas fiber, magnesium oxide, lactulose, senna and lubiprostone carry CONDITIONAL ones.