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Comparison 1 Acupuncture versus sham acupuncture, Outcome 1 Global symptom score (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 1.1

Comparison 1 Acupuncture versus sham acupuncture, Outcome 1 Global symptom score (Short‐term outcome ‐ end of treatment).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 2 Increased Barostat rectal sensory thresholds (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 1.2

Comparison 1 Acupuncture versus sham acupuncture, Outcome 2 Increased Barostat rectal sensory thresholds (Short‐term outcome ‐ end of treatment).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 3 Responder rate from 'Patient determined treatment success' & 'Global symptom score' (End of treatment).
Figures and Tables -
Analysis 1.3

Comparison 1 Acupuncture versus sham acupuncture, Outcome 3 Responder rate from 'Patient determined treatment success' & 'Global symptom score' (End of treatment).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 4 General well‐being (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.4

Comparison 1 Acupuncture versus sham acupuncture, Outcome 4 General well‐being (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 5 Abdominal pain (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.5

Comparison 1 Acupuncture versus sham acupuncture, Outcome 5 Abdominal pain (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 6 Defecation difficulties (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.6

Comparison 1 Acupuncture versus sham acupuncture, Outcome 6 Defecation difficulties (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 7 Diarrhea (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.7

Comparison 1 Acupuncture versus sham acupuncture, Outcome 7 Diarrhea (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 8 Alternating diarrhea and constipation (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.8

Comparison 1 Acupuncture versus sham acupuncture, Outcome 8 Alternating diarrhea and constipation (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 9 Bloating (After 1st session: i.e., Before cross‐over).
Figures and Tables -
Analysis 1.9

Comparison 1 Acupuncture versus sham acupuncture, Outcome 9 Bloating (After 1st session: i.e., Before cross‐over).

Comparison 1 Acupuncture versus sham acupuncture, Outcome 10 Symptom improvement assessed by blinded clinician (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 1.10

Comparison 1 Acupuncture versus sham acupuncture, Outcome 10 Symptom improvement assessed by blinded clinician (Short‐term outcome ‐ end of treatment).

Comparison 2 Ear acupuncture versus western medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 2.1

Comparison 2 Ear acupuncture versus western medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

Comparison 3 Acupuncture versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 3.1

Comparison 3 Acupuncture versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

Comparison 3 Acupuncture versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).
Figures and Tables -
Analysis 3.2

Comparison 3 Acupuncture versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 4.1

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).
Figures and Tables -
Analysis 4.2

Comparison 4 Acupuncture plus psychotherapy versus psychotherapy, Outcome 2 No symptom recurrence (6 month after treatment).

Comparison 5 Acupuncture versus herbal medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).
Figures and Tables -
Analysis 5.1

Comparison 5 Acupuncture versus herbal medication, Outcome 1 Symptom improved (Short‐term outcome ‐ end of treatment).

Table 1. Linde Internal Validity Scale (LIVS): items

LIVS items

scoring of items

1. Treatment allocation
a) randomized stated
b) not randomized
c) no or unclear information

1
0
0

2. Randomized concealment
a) adequate (e.g., central randomization, coded drugs etc.)
b) probably adequate (e.g., sealed envelope)
c) other:
d) inadequate concealment
e) no or unclear information

1
.5
depends
0
0

3. Baseline comparability
a) important baseline factors listed and comparable
b) baseline comparability fairly credible
c) important baseline differences
d) no or unclear information

1
.5
0
0

4. Blinding of patients
a) placebo/control indistinguishable
b) blinding only stated
c) placebo likely to be distinguishable
d) patients not blinded
e) no or unclear information

1
.5
0
0
0

5. Blinding of evaluators
a) blinding described and likely to be successful
b) blinding only stated
c) evaluators not blinded
d) no or unclear information

1
.5
0
0

6. Handling of withdrawals
a) no or minimal withdrawals/drop‐outs
b) less than 20% loss to follow up and intent‐to‐treat‐analysis
c) careful handling/description of withdrawals, substantial bias
d) major flaws
e) no or unclear information

1
1
.5
0
0

Figures and Tables -
Table 1. Linde Internal Validity Scale (LIVS): items
Table 2. Linde Internal Validity Scale: score

Study ID

1.

2.

3.

4.

5.

6.

LIVS score

Fireman 2001

1

0

0

1

1

.5

3.5

Forbes 2005

1

.5

1

1

1

.5

5

Liao 2000

1

0

0

0

0

0

1

Liu 1995

1

0

0

0

0

0

1

Liu 1997

1

0

0

0

0

0

1

Lowe 2000

1

0

.5

.5

.5

0

2.5

Figures and Tables -
Table 2. Linde Internal Validity Scale: score
Table 3. Jadad Quality of Methodology Scale: items

Quality items

1A. Was the study described as randomized?

1B. If answer to above is yes, was method of generating randomization sequence appropriate?

2A. Was the study described as double blind?

2B. If answer to above is yes, was the method of double blinding appropriate?

3. Was there a description of dropouts and withdrawals?

Note: A+B+C+D+E = possible 5 points on Jadad scale. Low quality = 0 to 2; high quality = 3 to 5.

Figures and Tables -
Table 3. Jadad Quality of Methodology Scale: items
Table 4. Jadad Methodological Quality Scale: score (Yes=1, No=0)

Study ID

1A

1B

2A

2B

3

Jadad score

Fireman 2001

1

0

1

1

1

4

Forbes 2005

1

1

1

1

1

5

Liao 2000

1

0

0

0

0

1

Liu 1995

1

0

0

0

0

1

Liu 1997

1

0

0

0

0

1

Lowe 2000

1

0

1

1

0

3

Figures and Tables -
Table 4. Jadad Methodological Quality Scale: score (Yes=1, No=0)
Comparison 1. Acupuncture versus sham acupuncture

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Global symptom score (Short‐term outcome ‐ end of treatment) Show forest plot

1

59

Std. Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.43, 0.60]

2 Increased Barostat rectal sensory thresholds (Short‐term outcome ‐ end of treatment) Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.71, 2.41]

3 Responder rate from 'Patient determined treatment success' & 'Global symptom score' (End of treatment) Show forest plot

2

109

Risk Ratio (M‐H, Fixed, 95% CI)

1.28 [0.83, 1.98]

4 General well‐being (After 1st session: i.e., Before cross‐over) Show forest plot

1

25

Std. Mean Difference (IV, Fixed, 95% CI)

0.55 [‐0.26, 1.35]

5 Abdominal pain (After 1st session: i.e., Before cross‐over) Show forest plot

1

23

Std. Mean Difference (IV, Fixed, 95% CI)

0.73 [‐0.12, 1.58]

6 Defecation difficulties (After 1st session: i.e., Before cross‐over) Show forest plot

1

13

Std. Mean Difference (IV, Fixed, 95% CI)

0.84 [‐0.32, 1.99]

7 Diarrhea (After 1st session: i.e., Before cross‐over) Show forest plot

1

11

Std. Mean Difference (IV, Fixed, 95% CI)

0.22 [‐0.97, 1.41]

8 Alternating diarrhea and constipation (After 1st session: i.e., Before cross‐over) Show forest plot

1

14

Std. Mean Difference (IV, Fixed, 95% CI)

0.83 [‐0.28, 1.94]

9 Bloating (After 1st session: i.e., Before cross‐over) Show forest plot

1

20

Std. Mean Difference (IV, Fixed, 95% CI)

0.21 [‐0.67, 1.09]

10 Symptom improvement assessed by blinded clinician (Short‐term outcome ‐ end of treatment) Show forest plot

1

59

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [0.81, 2.94]

Figures and Tables -
Comparison 1. Acupuncture versus sham acupuncture
Comparison 2. Ear acupuncture versus western medication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot

1

48

Risk Ratio (M‐H, Fixed, 95% CI)

1.49 [0.94, 2.34]

Figures and Tables -
Comparison 2. Ear acupuncture versus western medication
Comparison 3. Acupuncture versus psychotherapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.87, 1.26]

2 No symptom recurrence (6 month after treatment) Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

2.25 [0.80, 6.36]

Figures and Tables -
Comparison 3. Acupuncture versus psychotherapy
Comparison 4. Acupuncture plus psychotherapy versus psychotherapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.2 [1.03, 1.39]

2 No symptom recurrence (6 month after treatment) Show forest plot

1

48

Risk Ratio (M‐H, Fixed, 95% CI)

3.26 [1.22, 8.69]

Figures and Tables -
Comparison 4. Acupuncture plus psychotherapy versus psychotherapy
Comparison 5. Acupuncture versus herbal medication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Symptom improved (Short‐term outcome ‐ end of treatment) Show forest plot

1

132

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [1.00, 1.31]

Figures and Tables -
Comparison 5. Acupuncture versus herbal medication