Indiana University School of Medicine Indianapolis, IN
Wade Billings, MD, Karan Mathur, MD, Hannah J. Craven, MLIS, Huiping Xu, PhD, Andrea Shin, MD, MSc; Indiana University School of Medicine, Indianapolis, IN
Introduction: Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders in the world. Many patients with IBS seek complementary and alternative medicine (CAM), even when they are satisfied with conventional therapy. It is thus important for clinicians to understand the available evidence for CAM. The aim of this study was to perform a systematic review and meta-analysis examining the efficacy of CAM including herbal and dietary supplements, mind-body intervention, body-based methods, and energy-based therapies compared to placebo or sham therapy in adults with IBS. Methods: A literature search of Ovid MEDLINE and Embase for randomized, placebo-controlled trials of CAM in adults with IBS was completed. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain severity (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Heterogeneity was assessed using the Higgins and Thompson I2 statistic. Risk of bias was assessed using the Cochrane Collaboration Tool. Publication bias was tested using a funnel plot and Egger’s test. Results: The literature search identified 2053 articles; sixty were included in the final analysis (Figure 1): 50 for abdominal pain and 41 for overall response. Fourteen studies were considered to be at low risk of bias. Pooled analysis of effect on abdominal pain favored CAM (SMD=-0.25, 95% CI -0.41 to -0.08), but with moderate heterogeneity (I2=72%) between studies. Subgroup analysis (Figure 2) showed benefit with herbal (SMD=-0.36, 95% CI -0.62 to -0.10, I2=76%,) and mind-body based therapy (SMD=-0.22, 95% CI -0.42 to -0.01, I2=65%), although heterogeneity persisted. There was a significant effect on overall response favoring CAM (RR=1.54, 95% CI 1.34 to 1.77), but with moderate heterogeneity (I2=64%). Subgroup analysis (Figure 3) showed significant benefit with each class of CAM over placebo with the exception of body-based and energy healing therapies. No statistically significant evidence of publication bias was found. No study reported serious adverse events. Discussion: Findings suggest that CAM may be beneficial compared to placebo for abdominal pain and overall response. However, moderate heterogeneity between studies was observed and the majority of studies were considered to be at moderate to high risk of bias. More high quality placebo-controlled RCTs are warranted to further assess CAM therapy in IBS.
Figure 1. Study Selection
Figure 2. Forest plot of studies of CAM vs. placebo for effect on abdominal pain by therapy class
Figure 3. Forest plot of studies of CAM vs. placebo for effect on overall response by therapy class
Disclosures: Wade Billings indicated no relevant financial relationships. Karan Mathur indicated no relevant financial relationships. Hannah Craven indicated no relevant financial relationships. Huiping Xu indicated no relevant financial relationships. Andrea Shin indicated no relevant financial relationships.