Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults

doi:10.3748/wjg.v26.i41.6488

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World Journal of Gastroenterology

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Meta-Analysis

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.	Country	Classification of IBS, criterion	Sample size		Age in yr	Course of disease in yr	Treatment cycle in wk	Intervention		Endpoints	Follow-up	Side effects
Ref.	Country	Classification of IBS, criterion	EG, M/F	CG, M/F	Age in yr	Course of disease in yr	Treatment cycle in wk	EG	CG	Endpoints	Follow-up	Side effects
Yang et al[30], 2019	China	IBS-D (Rome III)	43/30	44/29	E: 43.93 ± 13.58 C: 45.00 ± 16.67	E: 3.74 ± 5.02 C: 4.12 ± 4.94	4	AP	Placebo	a, f, h	N/A	N/A
He et al[31], 2019	China	IBS-D (Rome IV)	13/12	14/11	E: 47.88 ± 15.16 C: 48.56 ± 17.4	N/A	4	AP	Probiotics	a, f, j	N/A	N/A
Li[32], 2019	China	IBS-D (Rome IV)	15/14	15/13	E: 45.30 ± 11.52 C: 48.33 ± 12.13 mo	E: 10.98 ± 5.12 C: 10.79 ± 5.04 mo	4	AP + MB	RPs	a, d, h, i	N/A	N/A
Wang et al[33], 2019	China	IBS (Rome IV)	25/31	23/32	E: 46.00 ± 2.50 C: 46.80 ± 2.70	E: 3.20 ± 1.40 C: 3.12 ± 1.38	4	AP + MB	RPs	a, h, j	N/A	N/A
Zhang et al[34], 2019	China	IBS (Rome III)	23/21	25/19	E: 47.23 ± 2.18 C: 47.66 ± 2.12	E: 5.22 ± 0.11 C: 5.26 ± 0.16	8	Probiotics	placebo	a, j	N/A	N/A
Peng et al[35], 2019	China	IBS-D (Rome IV)	14/16	16/14	E: 46.85 ± 14.45 C: 45.43 ± 13.58	E: 3.65 ± 1.15 C: 3.84 ± 1.32	4	BFT	Probiotics	a, d, f	N/A	N/A
Kou et al[36], 2018	China	IBS-D (Rome III)	16/29	18/27	E: 38.24 ± 6.58 C: 38.37 ± 6.60	N/A	4	Probiotics + RPs	RPs	a, b, e	N/A	E: 1 C: 2
Sun[37], 2018	China	IBS-D (Rome III)	63/42	53/42	E: 43.00 ± 12.45 C: 44.91 ± 13.01	N/A	4	Probiotics	placebo	b, d, f, k,	N/A	E: 6 C: 2
Qin et al[38], 2018	China	IBS (Rome III)	45/47	45/48	E: 42.8 ± 8.7 C: 44.2 ± 8.8	E: 4.5 ± 1.1 C: 4.5 ± 1.2	4	Probiotics + RPs	RPs	a, g, n	N/A	E: 0 C: 0
Zhang et al[39], 2018	China	IBS (Rome II)	15/28	17/26	E: 42.16 ± 7.24 C: 43.68 ± 9.09	N/A	4	CBT	RPs	d, o	N/A	N/A
Chen et al[40], 2017	China	IBS-D (Rome III)	31/13	30/14	E: 46.52 ± 3.75 C: 46.13 ± 3.82	N/A	4	Probiotics + RPs	RPs	a, g, j	N/A	N/A
Wang et al[41], 2017	China	IBS-D (Rome III)	17/21	16/22	E: 46.5 ± 2.3 C: 46.3 ± 2.2	E: 3.3 ± 0.8 C: 3.2 ± 0.7	4	Probiotics + RPs	RPs	a, b	N/A	E: 3 C: 1
Hod et al[42], 2017	United States	IBS-D (Rome III)	54	53	E: 29.0 C: 30.0	N/A	4	Probiotics	Placebo	a, b, e	N/A	E: 0 C: 0
Joo et al[43], 2017	Korea	IBS (Rome III)	9/17	5/19	E: 32.5 C: 33.0	N/A	4	Probiotics	Placebo	a, b, p	N/A	E: 0 C: 0
Liu et al[44], 2017	China	IBS-C (Rome III)	17/23	17/23	43.86 ± 10.29	2.93 ± 1.06	8	Probiotics + RPs	RPs	a, b, e, g	N/A	E: 0 C: 0
Huang[45], 2017	China	IBS-C (Rome III)	16/23	15/25	E: 44.23 ± 11.92 C: 41.54 ± 12.24	E: 4.11 ± 1.94 C: 3.54 ± 2.19	4	BFT	RPs	a, e, u	N/A	N/A
Cheng et al[46], 2017	China	IBS-D (Rome III)	19/22	18/21	E: 36.27 ± 2.78 C: 41.69 ± 12.63	N/A	8	CBT	RPs	d, f, o	N/A	N/A
Kang et al[47], 2016	China	IBS-D (Rome III)	17/23	16/24	E: 44.5 ± 6.4 C: 42.5 ± 7.2	N/A	4	Probiotic + RPs	RPs	a, i, j	N/A	N/A
Robin et al[48], 2016	France	IBS (Rome III)	31/161	31/156	E: 45.3 ± 15.7 C: 45.4 ± 14.1	N/A	12	Probiotics	Placebo	a, b, e, m	N/A	E: 10 C: 0
Zhang et al[49], 2016	China	IBS (Rome III)	12/18	14/16	E: 40.7 ± 11.4 C: 36.3 ± 14.1	E: 3.58 ± 2.04 C: 3.88 ± 2.36	4	Probiotics	RPs	a	N/A	E: 0 C: 2
Han et al[50], 2016	Korea	IBS (Rome III)	13/10	11/12	E: 45.7 ± 9.55 C: 42.5 ± 10.07	N/A	4	Probiotics	Placebo	a, k, l, p	N/A	N/A
Jia et al[51], 2016	China	IBS (Rome III)	16/14	22/10	E: 40.08 ± 13.23 C: 41.31 ± 11.82	N/A	8	CBT	RPs	f, o	N/A	N/A
Choi et al[52], 2015	South Korea	IBS (Rome III)	a: 20/34 b: 35/25 C: 35/23 d: 25/31	26/31	E: a: 44.8 ± 13.4 b: 48.9 ± 14.2 C: 46.2 ± 13.8 d: 45.9 ± 12.8 C: 48.5 ± 13.2	N/A	6	Probiotics + RPs	Placebo	a, b, m	N/A	E: 4/8/8/8 C: 6
Jia et al[53], 2015	China	IBS (Rome III)	N/A	N/A	E: 44.74 ± 11.98 C: 40.85 ± 13.87	N/A	8	CBT	RPs	d, o	N/A	N/A
Shi et al[54], 2015	China	IBS-D (Rome III)	28/32	25/35	E: 40.2 ± 10.8 C: 38.5 ± 9.1	E: 8.6 ± 3.8 C: 7.3 ± 2.1	4	AP	RPs	a	N/A	N/A
Li[55], 2015	China	IBS-D (Rome III)	N/A	N/A	E: 46 C: 46	E: 4.2 C: 4.2	4	AP	RPs + Probiotics	a, e, g	N/A	N/A
Ye et al[56], 2015	China	IBS (Rome III)	N/A	N/A	43.59 ± 12.17	2.42 ± 1.27	4	BFT + Probiotics	Probiotics	o, r, v	N/A	N/A
Zheng[57], 2014	China	IBS-D (Rome III)	49/40 49/36 40/42	52/34	E: 38.75 ± 18.32 42.66 ± 16.75 42.51 ± 16.78 C: 42.29 ± 18.30	E: 72.91 ± 76.70 78.83 ± 99.19 77.51 ± 84.56 C: 87.67 ± 90.28 d	4	AP	RPs	b, k, l, o, q, s	N/A	E: 3 C: 0
Zhu et al[58], 2014	China	IBS-D (Rome III)	9/6	7/6	E: 47.470 ± 0.896 C: 40.920 ± 10.136	E: 3.0 C: 3.5	4	MB	Placebo	d, t, u	N/A	N/A
Kong[59], 2014	China	IBS-D (Rome III)	14/16	9/21	E: 40 ± 9 C: 38 ± 11	E: 5.87 ± 6.52 C: 6.21 ± 6.33	4	AP+MB	RPs	a, d, e	N/A	N/A
He et al[60], 2014	China	IBS-D (Rome III)	N/A	N/A	37.3 ± 10.4	3.7 ± 2.1	4	BFT + RPs	RPs	a, g, i, n, v	N/A	N/A
Cheryl et al[61], 2014	South Africa	IBS (Rome III)	2/52	0/27	E: 48.15 ± 13.48 C: 47.27 ± 12.15	E: 9.58 ± 10.32 C: 10.05 ± 9.36	6	Probiotics	Placebo	b, d	N/A	E: 1 C: 0
Lesley et al[62], 2013	Britain	IBS (Rome III)	15/73	15/76	E: 44.66 ± 11.98 C: 43.71 ± 12.76	N/A	4	Probiotics	Placebo	a, d, e, f, m	N/A	N/A
Ge[63], 2013	China	IBS (Rome III)	34/26	32/28	E: 38.9 ± 11.2 C: 39.1 ± 10.3	E: 6.5 C: 6.4	4	AP	RPs	a, c	E: 6/52 C: 12/43	N/A
Pei et al[64], 2012	China	IBS-D (Rome III)	13/17	10/20	E: 39.10 ± 11.80 C: 37.93 ± 11.45	E: 4.33 ± 3.93 C: 5.23 ± 7.35	4	AP	RPs	a	N/A	N/A
Kruis et al[65], 2012	Germany	IBS (Rome II)	12/48	16/44	E: 46.3 ± 12.1 C: 45.1 ± 12.7	E: 12.3 ± 11.5 C: 11.7 ± 12.0	12	Probiotics	Placebo	a, b	N/A	E: 0 C: 1
Sun et al[66], 2011	China	IBS-D (Rome III)	13/18	20/12	E: 38.81 ± 11.80 C: 38.59 ± 11.45	E: 4.23 ± 3.96 C: 5.63 ± 7.35	4	AP	RPs	a, b, d, e	NA	E: 0 C: 0
Zeng et al[67], 2011	China	IBS-D (Rome III)	39/30	41/28	E: 38.5 ± 8.4 C: 37.9 ± 9.6	E: 3.7 ± 1.8 C: 3.5 ± 2.1	8	Probiotics + RPs	RPs	a, b, r	N/A	E: 14 C: 12
Zhao et al[68], 2011	China	IBS (Rome III)	N/A	N/A	38.6 ± 11.2	UN	4	BFT	RPs	o, r, v	N/A	N/A
Wang et al[69], 2008	China	IBS-D (Rome II)	N/A	N/A	E: 42.8 ± 12.4 C: 43.7 ± 11.7	E: 3.41 ± 1.02 C: 3.23 ± 1.31	4	AP	RPs	a	N/A	N/A

AP: Acupuncture; BFT: Biofeedback therapy; C: Control group; CBT: Cognitive behavior therapy; E: Experiment group; F: Female; IBS: Irritable bowel syndrome; IBS-C: Constipation-predominant irritable bowel syndrome; IBS-D: Diarrhea-predominant irritable bowel syndrome; M: Male; MB: Moxibustion; N/A: Not applicable; RPs: Routine pharmacotherapies (including antispasmodic, laxative, antidiarrheic, antidepressant, glutathione); TCM: Traditional Chinese medicine. a: Overall clinical efficacy; b: Adverse effect rate; c: Recurrent rate; d: IBS-QOL (Quality of life); e: Clinical symptoms scores (abdominal pain/discomfort, flatulence, diarrhea, stool frequency, stool consistency); f: IBS-SSS (IBS symptom severity scale); g: The expression of immunohistochemistry (5-HT, TNF-α, IL-8, IL-10, ); h: TCM symptom scores; i: HAMA & HAMD (The Hamilton Anxiety & Depression Rating Scale); j: Change in intestinal flora (Escherichia coli, Lactobacillus, Bifidobacterium, Enterococcus faecalis); k: Bristol Stool Form Scale; l: Frequency of clinical symptoms (abdominal pain, diarrhea, constipation); m: SGA (subject’s global assessment); n: BSS (Bowel Symptoms Scale); o: SAS and SDS (self-rating anxiety scale and self-rating depression scale); p: VAS-IBS (Visual Analogue Scale); q: SF-36 (The Medical Outcomes Study 36-item Short-form Healthy Survey); r: Total and specific scores of GSRS (Gastrointestinal Symptom Rating Scale); s: The weekly average number of days with normal defecations; t: fMRI Examination; u: The Birmingham IBS Symptom Scale; v: Rectal distention threshold comparison; w: Visceral Pain threshold.

Table 2 Risk ratios with 95% confidence interval of overall clinical efficacy

RPs
0.99 (0.85, 1.17)^a	Probiotics
0.81 (0.75, 0.88)^a	0.82 (0.69, 0.97)^a	RPs + probiotics
0.77 (0.70, 0.86)^a	0.78 (0.66, 0.91)^a	0.95 (0.84, 1.07)	Acupuncture
0.78 (0.64, 0.94)^a	0.78 (0.64, 0.95)^a	0.96 (0.78, 1.17)	1.01 (0.82, 1.23)	BFT
0.88 (0.77, 1.01)^a	0.88 (0.72, 1.09)	1.08 (0.92, 1.27)	1.14 (0.96, 1.35)	1.13 (0.89, 1.43)	Acupuncture + moxibustion

^aP < 0.05. The highlighted results indicate statistical significance. BFT: Biofeedback therapy; RPs: Routine pharmacotherapies.

Table 3 Standardized mean difference with 95% confidence interval of irritable bowel syndrome symptom severity scale

CBT
0.24 (-0.09, 0.57)^a	RPs
1.29 (0.43, 2.16)^a	1.05 (0.13, 1.97)	Acupuncture
2.09 (1.46, 2.73)^a	1.85 (1.13, 2.57)^a	0.80 (0.22, 1.38)	Probiotics
2.39 (1.71, 3.07)^a	2.15 (1.39, 2.90)^a	1.10 (0.48, 1.72)	0.30 (0.07, 0.52)^a	Placebo

^aP < 0.05. CBT: Cognitive behavioral therapy; RPs: Routine pharmacotherapies.

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)^a	0.26 (-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)^a	3.39 (1.19, 5.58)^a	3.13 (1.28, 4.97)^a	1.15 (-0.15, 2.45)	Probiotics
SDS
CBT
0.15 (-0.68, 0.99)^a	BFT
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)^a	RPs
2.97 (1.70, 4.23)^a	2.81 (1.86, 3.77)^a	2.36 (1.01, 3.72)^a	2.27 (1.06, 3.49)^a	Probiotics

^aP < 0.05. BFT: Biofeedback therapy; CBT: Cognitive behavioral therapy; CI: Confidence interval; RPs: Routine pharmacotherapies; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale; SMD: Standardized mean difference.

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

BFT: Biofeedback therapy; RPs: Routine pharmacotherapies.

Citation: Dai YK, Wu YB, Li RL, Chen WJ, Tang CZ, Lu LM, Hu L. Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults. World J Gastroenterol 2020; 26(41): 6488-6509
URL: https://www.wjgnet.com/1007-9327/full/v26/i41/6488.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i41.6488