Meta-Analysis
Copyright ©The Author(s) 2020.
World J Gastroenterol. Nov 7, 2020; 26(41): 6488-6509
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6488
Table 1 Characteristics of the studies included in the network analysis
Ref.CountryClassification of IBS, criterionSample size
Age in yrCourse of disease in yrTreatment cycle in wkIntervention
EndpointsFollow-upSide effects
EG, M/FCG, M/FEGCG
Yang et al[30], 2019ChinaIBS-D (Rome III)43/3044/29E: 43.93 ± 13.58 C: 45.00 ± 16.67E: 3.74 ± 5.02 C: 4.12 ± 4.944APPlaceboa, f, hN/AN/A
He et al[31], 2019ChinaIBS-D (Rome IV)13/1214/11E: 47.88 ± 15.16 C: 48.56 ± 17.4N/A4APProbioticsa, f, jN/AN/A
Li[32], 2019ChinaIBS-D (Rome IV)15/1415/13E: 45.30 ± 11.52 C: 48.33 ± 12.13 moE: 10.98 ± 5.12 C: 10.79 ± 5.04 mo4AP + MBRPsa, d, h, iN/AN/A
Wang et al[33], 2019ChinaIBS (Rome IV)25/3123/32E: 46.00 ± 2.50 C: 46.80 ± 2.70E: 3.20 ± 1.40 C: 3.12 ± 1.384AP + MBRPsa, h, jN/AN/A
Zhang et al[34], 2019ChinaIBS (Rome III)23/2125/19E: 47.23 ± 2.18 C: 47.66 ± 2.12E: 5.22 ± 0.11 C: 5.26 ± 0.168Probioticsplaceboa, jN/AN/A
Peng et al[35], 2019ChinaIBS-D (Rome IV)14/1616/14E: 46.85 ± 14.45 C: 45.43 ± 13.58E: 3.65 ± 1.15 C: 3.84 ± 1.324BFTProbioticsa, d, fN/AN/A
Kou et al[36], 2018ChinaIBS-D (Rome III)16/2918/27E: 38.24 ± 6.58 C: 38.37 ± 6.60N/A4Probiotics + RPsRPsa, b, eN/AE: 1 C: 2
Sun[37], 2018ChinaIBS-D (Rome III)63/4253/42E: 43.00 ± 12.45 C: 44.91 ± 13.01N/A4Probioticsplacebob, d, f, k,N/AE: 6 C: 2
Qin et al[38], 2018ChinaIBS (Rome III)45/4745/48E: 42.8 ± 8.7 C: 44.2 ± 8.8E: 4.5 ± 1.1 C: 4.5 ± 1.24Probiotics + RPsRPsa, g, nN/AE: 0 C: 0
Zhang et al[39], 2018ChinaIBS (Rome II)15/2817/26E: 42.16 ± 7.24 C: 43.68 ± 9.09N/A4CBTRPsd, oN/AN/A
Chen et al[40], 2017ChinaIBS-D (Rome III)31/1330/14E: 46.52 ± 3.75 C: 46.13 ± 3.82N/A4Probiotics + RPsRPsa, g, jN/AN/A
Wang et al[41], 2017ChinaIBS-D (Rome III)17/2116/22E: 46.5 ± 2.3 C: 46.3 ± 2.2E: 3.3 ± 0.8 C: 3.2 ± 0.74Probiotics + RPsRPsa, bN/AE: 3 C: 1
Hod et al[42], 2017United StatesIBS-D (Rome III)5453E: 29.0 C: 30.0N/A4ProbioticsPlaceboa, b, eN/AE: 0 C: 0
Joo et al[43], 2017KoreaIBS (Rome III)9/175/19E: 32.5 C: 33.0N/A4ProbioticsPlaceboa, b, pN/AE: 0 C: 0
Liu et al[44], 2017ChinaIBS-C (Rome III)17/2317/2343.86 ± 10.292.93 ± 1.068Probiotics + RPsRPsa, b, e, gN/AE: 0 C: 0
Huang[45], 2017ChinaIBS-C (Rome III)16/2315/25E: 44.23 ± 11.92 C: 41.54 ± 12.24E: 4.11 ± 1.94 C: 3.54 ± 2.194BFTRPsa, e, uN/AN/A
Cheng et al[46], 2017ChinaIBS-D (Rome III)19/2218/21E: 36.27 ± 2.78 C: 41.69 ± 12.63N/A8CBTRPsd, f, oN/AN/A
Kang et al[47], 2016ChinaIBS-D (Rome III)17/2316/24E: 44.5 ± 6.4 C: 42.5 ± 7.2N/A4Probiotic + RPsRPsa, i, jN/AN/A
Robin et al[48], 2016FranceIBS (Rome III)31/16131/156E: 45.3 ± 15.7 C: 45.4 ± 14.1N/A12ProbioticsPlaceboa, b, e, mN/AE: 10 C: 0
Zhang et al[49], 2016ChinaIBS (Rome III)12/1814/16E: 40.7 ± 11.4 C: 36.3 ± 14.1E: 3.58 ± 2.04 C: 3.88 ± 2.364ProbioticsRPsaN/AE: 0 C: 2
Han et al[50], 2016KoreaIBS (Rome III)13/1011/12E: 45.7 ± 9.55 C: 42.5 ± 10.07N/A4ProbioticsPlaceboa, k, l, pN/AN/A
Jia et al[51], 2016ChinaIBS (Rome III)16/1422/10E: 40.08 ± 13.23 C: 41.31 ± 11.82N/A8CBTRPsf, oN/AN/A
Choi et al[52], 2015South KoreaIBS (Rome III)a: 20/34 b: 35/25 C: 35/23 d: 25/3126/31E: a: 44.8 ± 13.4 b: 48.9 ± 14.2 C: 46.2 ± 13.8 d: 45.9 ± 12.8 C: 48.5 ± 13.2N/A6Probiotics + RPsPlaceboa, b, mN/AE: 4/8/8/8 C: 6
Jia et al[53], 2015ChinaIBS (Rome III)N/AN/AE: 44.74 ± 11.98 C: 40.85 ± 13.87N/A8CBTRPsd, oN/AN/A
Shi et al[54], 2015ChinaIBS-D (Rome III)28/3225/35E: 40.2 ± 10.8 C: 38.5 ± 9.1E: 8.6 ± 3.8 C: 7.3 ± 2.14APRPsaN/AN/A
Li[55], 2015ChinaIBS-D (Rome III)N/AN/AE: 46 C: 46E: 4.2 C: 4.24APRPs + Probioticsa, e, gN/AN/A
Ye et al[56], 2015ChinaIBS (Rome III)N/AN/A43.59 ± 12.172.42 ± 1.274BFT + ProbioticsProbioticso, r, vN/AN/A
Zheng[57], 2014ChinaIBS-D (Rome III)49/40 49/36 40/4252/34E: 38.75 ± 18.32 42.66 ± 16.75 42.51 ± 16.78 C: 42.29 ± 18.30E: 72.91 ± 76.70 78.83 ± 99.19 77.51 ± 84.56 C: 87.67 ± 90.28 d4APRPsb, k, l, o, q, sN/AE: 3 C: 0
Zhu et al[58], 2014ChinaIBS-D (Rome III)9/67/6E: 47.470 ± 0.896 C: 40.920 ± 10.136E: 3.0 C: 3.54MBPlacebod, t, uN/AN/A
Kong[59], 2014ChinaIBS-D (Rome III)14/169/21E: 40 ± 9 C: 38 ± 11E: 5.87 ± 6.52 C: 6.21 ± 6.334AP+MBRPsa, d, eN/AN/A
He et al[60], 2014ChinaIBS-D (Rome III)N/AN/A37.3 ± 10.43.7 ± 2.14BFT + RPsRPsa, g, i, n, vN/AN/A
Cheryl et al[61], 2014South AfricaIBS (Rome III)2/520/27E: 48.15 ± 13.48 C: 47.27 ± 12.15E: 9.58 ± 10.32 C: 10.05 ± 9.366ProbioticsPlacebob, dN/AE: 1 C: 0
Lesley et al[62], 2013BritainIBS (Rome III)15/7315/76E: 44.66 ± 11.98 C: 43.71 ± 12.76N/A4ProbioticsPlaceboa, d, e, f, mN/AN/A
Ge[63], 2013ChinaIBS (Rome III)34/2632/28E: 38.9 ± 11.2 C: 39.1 ± 10.3E: 6.5 C: 6.44APRPsa, cE: 6/52 C: 12/43N/A
Pei et al[64], 2012ChinaIBS-D (Rome III)13/1710/20E: 39.10 ± 11.80 C: 37.93 ± 11.45E: 4.33 ± 3.93 C: 5.23 ± 7.354APRPsaN/AN/A
Kruis et al[65], 2012GermanyIBS (Rome II)12/4816/44E: 46.3 ± 12.1 C: 45.1 ± 12.7E: 12.3 ± 11.5 C: 11.7 ± 12.012ProbioticsPlaceboa, bN/AE: 0 C: 1
Sun et al[66], 2011ChinaIBS-D (Rome III)13/1820/12E: 38.81 ± 11.80 C: 38.59 ± 11.45E: 4.23 ± 3.96 C: 5.63 ± 7.354APRPsa, b, d, eNAE: 0 C: 0
Zeng et al[67], 2011ChinaIBS-D (Rome III)39/3041/28E: 38.5 ± 8.4 C: 37.9 ± 9.6E: 3.7 ± 1.8 C: 3.5 ± 2.18Probiotics + RPsRPsa, b, rN/AE: 14 C: 12
Zhao et al[68], 2011ChinaIBS (Rome III)N/AN/A38.6 ± 11.2UN4BFTRPso, r, vN/AN/A
Wang et al[69], 2008ChinaIBS-D (Rome II)N/AN/AE: 42.8 ± 12.4 C: 43.7 ± 11.7E: 3.41 ± 1.02 C: 3.23 ± 1.314APRPsaN/AN/A
Table 2 Risk ratios with 95% confidence interval of overall clinical efficacy
RPs
0.99 (0.85, 1.17)aProbiotics
0.81 (0.75, 0.88)a0.82 (0.69, 0.97)aRPs + probiotics
0.77 (0.70, 0.86)a0.78 (0.66, 0.91)a0.95 (0.84, 1.07)Acupuncture
0.78 (0.64, 0.94)a0.78 (0.64, 0.95)a0.96 (0.78, 1.17)1.01 (0.82, 1.23)BFT
0.88 (0.77, 1.01)a0.88 (0.72, 1.09)1.08 (0.92, 1.27)1.14 (0.96, 1.35)1.13 (0.89, 1.43)Acupuncture + moxibustion
Table 3 Standardized mean difference with 95% confidence interval of irritable bowel syndrome symptom severity scale
CBT
0.24 (-0.09, 0.57)aRPs
1.29 (0.43, 2.16)a1.05 (0.13, 1.97)Acupuncture
2.09 (1.46, 2.73)a1.85 (1.13, 2.57)a0.80 (0.22, 1.38)Probiotics
2.39 (1.71, 3.07)a2.15 (1.39, 2.90)a1.10 (0.48, 1.72)0.30 (0.07, 0.52)aPlacebo
Table 4 Standardized mean difference with 95% confidence interval of self-rating anxiety scale and self-rating depression scale
SMD (95%CI)
SAS
CBT
0.05 (-1.29, 1.39)Acupuncture
0.31 (-0.31, 0.94)a0.26 (-0.92, 1.45)RPs
2.28 (0.83, 3.74)2.24 (0.47, 4.01)1.97 (0.66, 3.29)BFT
3.44 (1.49, 5.39)a3.39 (1.19, 5.58)a3.13 (1.28, 4.97)a1.15 (-0.15, 2.45)Probiotics
SDS
CBT
0.15 (-0.68, 0.99)aBFT
0.61 (-0.10, 1.31)0.45 (-0.51, 1.42)Acupuncture
0.69 (0.33, 1.06)0.54 (-0.21, 1.29)0.09 (-0.51, 0.69)aRPs
2.97 (1.70, 4.23)a2.81 (1.86, 3.77)a2.36 (1.01, 3.72)a2.27 (1.06, 3.49)aProbiotics
Table 5 Risk ratios with 95% confidence interval of adverse effects
RPs
0.99 (0.35, 2.81)Placebo
0.85 (0.45, 1.59)0.86 (0.37, 1.97)BFT
0.39 (0.02, 9.12)0.39 (0.01, 10.93)0.46 (0.02, 11.47)Moxibustion
0.50 (0.13, 1.89)0.51 (0.22, 1.15)0.59 (0.18, 1.90)1.29 (0.04, 39.33)Probiotics
0.40 (0.09, 1.88)0.41 (0.06, 2.62)0.47 (0.09, 2.51)1.03 (0.07, 16.13)0.80 (0.10, 6.13)Acupuncture