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 [PMID: 33244207 DOI: 10.3748/wjg.v26.i41.6488]
Corresponding Author of This Article
Ling Hu, PhD, Professor, Institute of Gastroenterology, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, No. 12 Jichang Road, Baiyun District, Guangzhou 510405, Guangdong Province, China. drhuling@163.com
Research Domain of This Article
Integrative & Complementary Medicine
Article-Type of This Article
Meta-Analysis
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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 [PMID: 33244207 DOI: 10.3748/wjg.v26.i41.6488]
Yun-Kai Dai, Yun-Bo Wu, Ru-Liu Li, Wei-Jing Chen, Ling Hu, Institute of Gastroenterology, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Chun-Zhi Tang, Li-Ming Lu, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Author contributions: Hu L and Lu LM conceived and designed the study; Dai YK and Wu YB performed the experiment and analyzed the data; Dai YK wrote the paper; Li RL, Chen WJ, Tang CZ, Lu LM and Hu L supervised the study; All authors approved the final manuscript as submitted.
Supported byNational Natural Science Foundation of China, No. 81774238, No. 81373563, and No. 30772689; Construction of Chinese First-class Discipline of Guangzhou University of Chinese Medicine, 2017, No. 70; Construction of Chinese First-class Discipline Research of Key Project of Guangzhou University of Chinese Medicine ([2020] No. 62, [2019] No. 5, and [2018] No. 6); Construction of High-level University of Guangzhou University of Chinese Medicine (2016, No. 64); and Innovation Team to Foster Scientific Research Projects of Guangzhou University of Chinese Medicine, No. 2016KYTD07.
Conflict-of-interest statement: All authors disclosed no competing interests in any aspects.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Ling Hu, PhD, Professor, Institute of Gastroenterology, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, No. 12 Jichang Road, Baiyun District, Guangzhou 510405, Guangdong Province, China. drhuling@163.com
Received: July 10, 2020 Peer-review started: July 10, 2020 First decision: August 8, 2020 Revised: August 21, 2020 Accepted: September 18, 2020 Article in press: September 18, 2020 Published online: November 7, 2020 Processing time: 119 Days and 4 Hours
Abstract
BACKGROUND
Although nonpharmacological interventions (NPI) for irritable bowel syndrome (IBS) have been applied clinically, their relative efficacy and safety are poorly understood.
AIM
To compare and rank different NPI in the treatment of IBS.
METHODS
Five electronic databases were searched from their inception to January 12, 2020. Data of included publications were analyzed using network meta-analysis (NMA). Quality of endpoints were assessed by tools of the Cochrane Handbook and the GRADEpro software. Pooled relative risk or standardized mean difference with their corresponding 95% confidence intervals were used for statistical analysis. Surface under the cumulative ranking curve (SUCRA) probability value was conducted to rank the examined interventions. Sensitivity analysis was performed to verify the robustness of results and test the source of heterogeneity.
RESULTS
Forty randomized controlled trials with 4196 participants were included in this NMA. Compared with routine pharmacotherapies and placebo, acupuncture and cognitive behavioral therapy (CBT) had better efficacy in relieving IBS symptoms. Based on the SUCRA values, acupuncture ranked first in improving overall clinical efficacy and avoiding adverse effects. CBT ranked first in lowering the scores of IBS symptom severity scale, self-rating anxiety scale and self-rating depression scale.
CONCLUSION
This study confirmed the efficacy and safety of NPI for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.
Core Tip: This is the first study to compare nonpharmacological interventions including biofeedback, cognitive behavioral therapy, probiotics, dietary, acupuncture, and moxibustion using network meta-analysis.
