Complementary and alternative medicines in irritable bowel syndrome: An integrative view

Table 1 Clinical trials on diet and exercise interventions for irritable bowel syndrome

Intervention	Study design	Sample size	Outcome	Ref.
Acceptability questionnaire	Anonymous survey	256	Most acceptable were tablets (84%), diet and lifestyle changes (82%), yoga (77%); less acceptable were acupuncture (59%) and suppositories (57%)	[40]
Food elimination	Open label pilot study	20	Significant improvements in stool frequency (P < 0.05), pain (P < 0.05), and IBS-QOL (P < 0.001)	[89]
Diet and lifestyle	Cross-sectional study	1717	Significant difference between IBS and non-IBS participants in regards to residential type (OR = 1.27) and frequency of meals (OR = 1.69)	[90]
Diet and lifestyle	Questionnaire	983	BMI was associated with abdominal pain and diarrhea, healthier diet and physical activity were associated with fewer GI symptoms	[91]
Diet	3-way cross-over study	22	IBS-D patients showed significant increase in small bowel and mucosal permeability for mannitol and lactulose sugars compared to healthy controls	[92]
Diet	Questionnaire	1978	Potential for higher lactose intolerance incidence in patients with IBS compared to healthy patients	[93]
Diet	Case-control study	177	Symptomatic lactose intolerance more frequent in patients with IBS than healthy subjects, but incidence of lactose intolerance not different between groups	[94]
Diet	Case-control study	120	Lactose intolerance resulted in more frequent self-reported symptoms in patients with IBS-D than controls (P < 0.001, OR = 6.25), IBS-D patients consumed significantly less dairy products (P = 0.04)	[95]
Exercise	Randomized, controlled trial	56	No difference in quality of life between exercise and usual care groups, exercise group presented with significant less symptoms of constipation after 12 wk intervention	[98]
Exercise	Cross-over study	8	Gas retention during rest was associated with significant abdominal symptoms in IBS patients (P < 0.01), symptoms improved during exercise (P < 0.05) compared to rest	[99]
Exercise	Descriptive comparative study	89	Women with IBS report less physical activity (P < 0.05), women with IBS who were physical active reported significantly less symptoms of fatigue (P = 0.003) compared with the ones with IBS who were physically inactive	[100]
Yoga	Randomized cross-over study	25	Lower functional disability (P = 0.073) and anxiety levels (P = 0.09) in the yoga group compared to the waitlist group, significantly lower GI symptoms (P < 0.01)	[101]
Yoga	Randomized parallel design	21	Similar reductions in symptoms after 2 mo for yoga and the group receiving loperamide in IBS-D patients	[102]

IBS: Irritable bowel syndrome; QOL: Quality of life; BMI: Body mass index; IBS-D: Diarrhea-predominant IBS; GI: Gastrointestinal.