Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Clin Gastroenterol Hepatol. 2021 Aug;19(8):1538-1553.e14. doi: 10.1016/j.cgh.2020.09.035. Epub 2020 Sep 19.
BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS.
Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed.
Among 2825 articles identified, 66 were included. Herbal therapy (SMD=0.47, 95% CI: 0.20 to 0.75, I=82%) demonstrated significant benefit over placebo for abdominal pain (low confidence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD=0.29, 95% CI: -0.01 to 0.59, I=78%). Herbal therapy (RR=1.57, 95% CI: 1.31 to 1.88, I=77%), dietary supplements (RR=1.95, 95% CI: 1.02 to 3.73, I=75%), and mind-body based therapy (RR=1.67, 95% CI: 1.13 to 2.49, I=63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies demonstrated no significant benefit over placebo or sham for abdominal pain or overall response.
CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.
肠易激综合征（IBS）患者可能会寻求补充和替代医学（CAM）。我们进行了一项全面的系统评价和荟萃分析，研究了 CAM 与安慰剂或假对照在成人 IBS 中的疗效。
检索了针对成人 IBS 的 CAM 疗法（草药治疗、膳食补充剂、身心基础、身体基础和能量治疗）的随机对照试验的出版数据库。提取数据以获得腹痛总体缓解的 pooled 估计值（标准化均数差 [SMD]）和总体反应的相对风险（RR），使用随机效应模型。完成了敏感性和亚组分析以及质量评估。
在确定的 2825 篇文章中，有 66 篇被纳入。与安慰剂相比，草药治疗（SMD=0.47，95%CI：0.20 至 0.75，I=82%）在腹痛方面显示出显著的益处（对估计值的信心较低）。身心基础疗法对腹痛的益处具有边缘显著性（SMD=0.29，95%CI：-0.01 至 0.59，I=78%）。与安慰剂相比，草药治疗（RR=1.57，95%CI：1.31 至 1.88，I=77%）、膳食补充剂（RR=1.95，95%CI：1.02 至 3.73，I=75%）和身心基础疗法（RR=1.67，95%CI：1.13 至 2.49，I=63%）在总体反应方面显示出益处（对估计值的信心较低）。与安慰剂或 sham 相比，身体基础和能量治疗在腹痛或总体反应方面没有显示出显著的益处。
CAM 疗法，如草药或膳食补充剂和身心基础方法，可能对 IBS 的腹痛和总体反应有益。然而，总体证据质量较低。需要进行严格、高质量的临床试验来研究 IBS 中的 CAM。
