Acupuncture for treatment of irritable bowel syndrome
Abstract
Background
Irritable bowel syndrome (IBS), a disorder of altered bowel habits associated with abdominal pain or discomfort. The pain, discomfort, and impairment from IBS often lead to healthcare medical consultation (Talley 1997) and workplace absenteeism, and associated economic costs (Leong 2003). A recent randomized controlled trial shows variable results but no clear evidence in support of acupuncture as an effective treatment for IBS (Fireman 2001).
Objectives
The objective of this systematic review is to determine whether acupuncture is more effective than no treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. Adverse events associated with acupuncture were also assessed.
Search methods
The following electronic bibliographic databases were searched irrespective of language, date of publication, and publication status: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to Nursing and Allied Health (CINAHL), and the Allied and Complementary Medicine Database (AMED). References in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February 2006.
Selection criteria
Published reports of randomized controlled trials (RCTs) and quasi‐randomised trials of acupuncture therapy for IBS.
Data collection and analysis
All eligible records identified were dually evaluated for eligibility and dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity Scale.
Data from individual trials were combined for meta‐analysis when the interventions were sufficiently similar. Heterogeneity was assessed using the I squared statistic.
Main results
Six trials were included. The proportion of responders, as assessed by either the global symptom score or the patient‐determined treatment success rate, did not show a significant difference between the acupuncture and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98;n=109). Acupuncture treatment was also not significantly more effective than sham acupuncture for overall general well‐being, individual symptoms (e.g., abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI 1.00 to 1.31;n=132); acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to 1.39;n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of 1.49(95% CI 0.94 to 2.34;n=48).
Authors' conclusions
Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.
PICOs
Plain language summary
Acupuncture for treatment of irritable bowel syndrome
Irritable bowel syndrome (IBS) is a disorder of altered bowel habits associated with abdominal pain or discomfort. Therapies for irritable bowel syndrome are generally directed at gastrointestinal motor, gastrointestinal sensory, or central nervous system processing; however, the efficacy of such conventional therapies varies from study to study, and the possibility of placebo effects make short‐term studies difficult to interpret. The lack of effective therapies for irritable bowel syndrome is accompanied by increased use of complementary and alternative therapies, such as acupuncture. Acupuncture is receiving increasing acceptance in Western medicine for treating certain gastrointestinal disorders. When randomized controlled trials of acupuncture for irritable bowel syndrome were evaluated, some trials showed no clear evidence in support of acupuncture as an effective treatment for IBS, although other poor quality trials showed beneficial effects of acupuncture. There is no evidence to support the use of acupuncture for the treatment of irritable bowel syndrome. Acupuncture for irritable bowel syndrome needs further investigation.
