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.

Table 2 Clinical trials on Herbal medicines and supplements for irritable bowel syndrome

Intervention	Study design	Sample size	Outcome	Ref.
Peppermint oil	Randomized, double-blind, placebo-controlled study	99	Peppermint oil (Colpermin®) group showed significant symptom improvement (P < 0.05) compared to placebo group after 1 mo	[104]
Peppermint oil	Randomized, placebo-controlled study	18	Peppermint oil significantly reduced GI symptoms (P < 0.01) after 3 wk compared to placebo	[106]
Peppermint oil	Randomized, double-blind. Placebo-controlled study	57	Total IBS severity score was significantly decreased after 4 wk of treatment (P < 0.009) and after 2 mo (P < 0.01) in the peppermint oil group compared to placebo	[108]
Peppermint oil	Randomized, double-blind, placebo-controlled study	90	Significant reduction in IBS symptoms, no abdominal pain in more patients in the peppermint oil group compared to placebo (P < 0.001), less severe abdominal pain in peppermint oil group (P < 0.05) in peppermint oil group after 2 mo	[109]
Peppermint oil	Randomized, double-blind, placebo-controlled study	65	Significant reduction in abdominal pain in peppermint oil group compared to placebo group (P < 0.001), but pain score increased 2 wk after completion of trial	[110]
Artichoke leaf	Post-marketing surveillance	279	Significant reduction (P < 0.05) in overall IBS symptoms after 6 wk of treatment	[113]
Artichoke leaf	Post-marketing surveillance in IBS with concomitant dyspepsia	209	Significant reduction in Nepean Dyspepsia Index after 2 mo (P < 0.001) and normalization of bowel pattern (P < 0.001)	[114]
Turmeric	Partially blinded, randomized, two-dose pilot study	207	Reduction in IBS prevalence in both treatment groups (1 or 2 tablets) compared to baseline (P < 0.001) after 2 mo intervention, no significant differences between groups	[116]
Curcuma and fumitory	Randomized, double-blind, placebo-controlled study	106	No significant differences between curcuma, fumitory, and placebo groups in abdominal pain (P = 0.81) and distension (P = 0.48) after 3 mo	[117]
STW5	Randomized, double-blind, placebo-controlled study in patients with dyspepsia	137	Significant decrease in gastrointestinal symptom score between STW5 and placebo (P < 0.001)	[118]
STW5	Randomized, double-blind, placebo-controlled multicenter study in patients with functional dyspepsia	315	Significant decrease in gastrointestinal symptom score between STW5 and placebo (P < 0.05) after 2 mo intervention	[119]
STW5	Randomized, double-blind, placebo-controlled multicenter study	203	Significant reduction in abdominal pain scores for STW5 (P = 0.009) and STW5-II (P = 0.005) and IBS-SSS (P = 0.001 for STW5 and P = 0.0003 for STW5-II) compared to placebo after 4 wk intervention	[120]
Padma Lax	Randomized, double-blind, placebo-controlled pilot study	61	Significant improvement in global IBS symptom scores compared to placebo (P < 0.05) following 3 mo intervention	[123]
TCM	Randomized, double-blind, placebo-controlled study	119	No significant improvements in IBS global symptom score between TCM and placebo group at week 8 (P = 0.38) and week 16 (P = 0.62)	[129]

IBS: Irritable bowel syndrome; TCM: Traditional chinese medicine; SSS: Symptom severity scale.

Table 3 Clinical trials on mechanical complementary and alternative medicines interventions for irritable bowel syndrome

Intervention	Study design	Sample size	Outcome	Ref.
Physical activity	Randomized study	75	Significant decrease in IBS-SSS between physical activity and placebo group (P = 0.003)	[133]
Reflexology	Randomized, single-blind, placebo-controlled study	34	No significant difference between foot reflexology and non-reflexology massage group	[134]
Acupuncture	Randomized, single-blind, placebo-controlled study	230	Acupuncture and sham acupuncture significantly improved IBS-GIS scores compared to waitlist group (P = 0.001), no difference between acupuncture and sham acupuncture during 3 wk intervention	[143]
Acupuncture	Randomized, single-blind, placebo-controlled study	43	Significant improvements (P = 0.022) in quality of life for both acupuncture and sham acupuncture compared to baseline after 10 intervention sessions (5 wk), no differences between acupuncture and sham acupuncture	[144]
Acupuncture/ moxibustion	Randomized, single-blind, placebo-controlled study	29	Significant reduction in IBS-SSS in acupuncture/moxibustion group after 4 wk compared to sham acupuncture/moxibustion group (P = 0.01)	[146]
Yoga	Observational pilot study (adolescents)	20	Decrease in pain frequency (P = 0.031 for 8-11 yr old and P = 0.004 for 12-18 yr old) and pain intensity (P = 0.015 in 8-11 yr old) after 10 yoga sessions compared to baseline, decrease in pain frequency was maintained for 3 mo following intervention (P = 0.004 for 8-11 yr old)	[149]

IBS: Irritable bowel syndrome; GIS: Global improvement scores; SSS: Symptom severity scale.

Table 4 Clinical trials on psychological complementary and alternative medicines interventions for irritable bowel syndrome

Intervention	Study design	Sample size	Outcome	Ref.
Hypnotherapy	Pre- and post-assessment	23	Normalized hypersensitivity pain threshold in hypersensitive group (P = 0.04) after 12 wk of treatment, no significant change in hyposensitive and normosensitive groups	[154]
Hypnotherapy	Randomized controlled trial in children with functional abdominal pain or IBS	53	Significant reduction in pain scores in hypnotherapy group (P < 0.001) compared to standard medical therapy at 1-yr after intervention	[159]
Hypnotherapy	Questionnaire	83	69% of patients were either satisfied or very satisfied with hypnotherapy following 12 wk intervention, overall improvement in quality of life and GI symptoms	[160]
Hypnotherapy	Randomized, placebo-controlled study	138 in two studies (90 and 48)	Significant reduction in IBS symptoms in hypnotherapy groups (P < 0.05) compared to supportive therapy after 3 mo of intervention	[161]
Hypnotherapy	Randomized, placebo-controlled study	90	Significant improvement in overall IBS symptoms in gut-directed hypnotherapy and medical treatment group compared to medical treatment group alone (P = 0.046) after 12 wk; improvement remained up to 12 mo after intervention in hypnotherapy group (P = 0.004) compared to medical treatment alone	[162]
Hypnotherapy	Pre- and post-assessment	75	Group hypnotherapy decreased symptom severity significantly (P < 0.01) at 3, 6, and 12 mo post-intervention	[163]
Hypnotherapy	Retrospective analysis	208	Significantly higher use of hypnotherapy (P < 0.001) by initial responders vs non-responders at 2-7 yr follow-up, in total 87% of participants reported hypnotherapy to be useful	[164]
Cognitive behavior therapy	Randomized-comparator-controlled study in patients with functional bowel disorders	431	CBT was more effective than education (P = 0.0001) and desipramine was more effective than placebo (P = 0.01) after 12 wk of treatment as assessed by treatment satisfaction	[170]
Cognitive behavior therapy	Randomized, placebo-controlled study in patients with functional bowel disorders	397	No significant differences between treatment arms for desipramine, cognitive behavior therapy, and placebo groups	[171]
Cognitive behavior therapy and mindfulness training	Randomized controlled trial	195	Internet-delivered cognitive behavior therapy resulted in adequate relief of IBS symptoms that was significant compared to internet-delivered stress management at 6 mo follow-up (P = 0.004)	[173]
Cognitive behavior therapy	Randomized controlled trial	149	Significant reduction in symptom severity scores in CBT plus mebeverine group compared to mebeverine alone at post-treatment and 3, 6, and 12 mo follow-up (regression P = 0.001)	[174]
Psychotherapy [cognitive behavior therapy]	Randomized controlled trial	50	Rome-II scores significantly decreased (P = 0.001) in patients receiving CBT in conjunction with standard medical care compared to standard medical care alone after 2 mo intervention	[175]
Cognitive behavior therapy	Randomized controlled trial	28	Psychosocial functioning was significantly improved (P = 0.004) in patients receiving CBT in addition to standard medical care compare to standard medical care alone at 3 mo follow-up	[176]
Cognitive behavior therapy	Randomized controlled trial	76	Cognitive behavior therapy presented with significant improvements compared to stress management and attention control groups in reducing visceral sensitivity (P < 0.0001) compared to baseline at 3 mo follow-up	[177]
Cognitive behavior therapy	Randomized, placebo-controlled study	85	Internet delivered CBT reduced several IBS symptom parameters (total pain, diarrhea, bloating primary symptoms all P < 0.001) after 10 wk of intervention compared to discussion board control group; quality of life and visceral sensitivity were also significantly improved (P < 0.001) after 3 mo follow up	[179]
Mindfulness training	Randomized controlled trial	75	Women in mindfulness training group showed significant reduction (P = 0.006) in IBS symptom severity compared to support control group after 8 wk of intervention which remained significant at 3 mo follow-up (P = 0.001)	[180]
Cognitive behavior therapy	Retrospective analysis	75	Long-term follow-up after 15-18 mo of original intervention resulted in lasting significant reductions in visceral sensitivity (P < 0.05), increase in quality of life (P < 0.05), and gastrointestinal symptoms (P < 0.05)	[181]

IBS: Irritable bowel syndrome; CBT: Cognitive behavior therapy; GI: Gastrointestinal.