Anorectal Disease Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Neurogastroenterol Motil. 2021 Aug;33(8):e14107. doi: 10.1111/nmo.14107. Epub 2021 Mar 4.
Chinese herbal medicine (CHM) is gaining popularity in treating irritable bowel syndrome (IBS). Although its efficacy was shown in recent randomized controlled trials (RCTs), it is rarely compared with antispasmodics to confirm its effectiveness. We aimed to resolve this uncertainty through a network meta-analysis.
We searched for RCTs that compared CHM or antispasmodics with placebo or one of them in the treatment of IBS. The primary outcomes were adequate relief of global IBS symptoms and abdominal pain. The data were pooled using a random-effects model. The effect size measure was pooled relative risk (RR), and treatments were ranked according to their P-scores.
We included 57 RCTs (n = 8869). After completion of treatment, drotaverine, individual CHM, otilonium, cimetropium, standard CHM, and pinaverium were efficacious in adequate relief of global IBS symptoms, and drotaverine ranked the first (RR, 2.33 [95% CI, 1.31-4.14], P-score =0.91); no difference was found between these treatments. After completion of treatment, drotaverine, standard CHM, pinaverium, and individual CHM were efficacious in abdominal pain, and drotaverine ranked the first (RR, 2.71 [95% CI, 1.69-4.36], P-score =0.91); no difference was found between these treatments. Standard CHM had significantly more adverse events than placebo (RR, 1.82 [95% CI, 1.12-2.94]) and other treatments.
CHM and antispasmodics were efficacious for improvement of global IBS symptoms and abdominal pain. The adverse events of CHM were higher than antispasmodics; however, the heterogeneity of CHM formulas and the very low quality of the evidence warrants further investigation.
中药（CHM）在治疗肠易激综合征（IBS）方面越来越受欢迎。尽管最近的随机对照试验（RCT）显示了其疗效，但很少将其与抗痉挛药进行比较以确认其有效性。我们旨在通过网络荟萃分析来解决这一不确定性。
我们检索了比较 CHM 或抗痉挛药与安慰剂或其中一种药物治疗 IBS 的 RCT。主要结局是整体 IBS 症状和腹痛的充分缓解。使用随机效应模型汇总数据。效应量测量为汇总相对风险（RR），并根据 P 评分对治疗方法进行排名。
我们纳入了 57 项 RCT（n=8869）。治疗完成后，莨菪碱、个体 CHM、奥替溴铵、西咪替丁、标准 CHM 和匹维溴铵在充分缓解整体 IBS 症状方面有效，莨菪碱排名第一（RR，2.33[95%CI，1.31-4.14]，P 评分=0.91）；这些治疗方法之间没有差异。治疗完成后，莨菪碱、标准 CHM、匹维溴铵和个体 CHM 在缓解腹痛方面有效，莨菪碱排名第一（RR，2.71[95%CI，1.69-4.36]，P 评分=0.91）；这些治疗方法之间没有差异。标准 CHM 比安慰剂（RR，1.82[95%CI，1.12-2.94]）和其他治疗方法的不良反应发生率更高。
CHM 和抗痉挛药可有效改善整体 IBS 症状和腹痛。CHM 的不良反应发生率高于抗痉挛药；然而，CHM 配方的异质性和证据质量极低，需要进一步研究。
