Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3486-3504
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3486
Irritable bowel syndrome and functional constipation management with integrative medicine: A systematic review
Liang Dai, Linda LD Zhong, Guang Ji
Liang Dai, Linda LD Zhong, Guang Ji, Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Linda LD Zhong, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
Author contributions: Dai L and Zhong LLD conducted the literature search and analysis; Ji G reviewed the results and made revisions to the manuscript; Dai L drafted the manuscript; all authors reviewed and approved the final manuscript for submission.
Supported by Shanghai Three-year Action Plan for Accelerating the Development of Traditional Chinese Medicine, No. ZY(2018-2020)-CCCX-2002-01.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Guang Ji, MD, PhD, Chief Physician, Director, Doctor, Full Professor, Occupational Physician, Professor, Research Scientist, Teacher, Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Xuhui District, Shanghai 200032, China. jiliver@vip.sina.com
Telephone: +86-21-64385700
Received: April 24, 2019
Peer-review started: April 24, 2019
First decision: June 28, 2019
Revised: July 5, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: November 6, 2019
Processing time: 198 Days and 2.6 Hours
Abstract
BACKGROUND

Irritable bowel syndrome (IBS) and functional constipation (FC) are two commonly encountered functional gastrointestinal disorders in clinical practice and are usually managed with Western medicines in cooperation with traditional Chinese medicine (TCM) interventions. Although clinical practice guidelines (CPGs) have been developed to assist clinicians with their decisions, there are still gaps in management with regard to integrative medicine (IM) recommendations.

AIM

To comprehensively review the currently available CPGs and to provide a reference for addressing the gaps in IBS and FC management.

METHODS

We searched mainstream English and Chinese databases and collected data from January 1990 to January 2019. The search was additionally enriched by manual searches and the use of publicly available resources. Based on the development method, the guidelines were classified into evidence-based (EB) guidelines, consensus-based (CB) guidelines, and consensus-based guidelines with no comprehensive consideration of the EB (CB-EB) guidelines. With regard to the recommendations, the strength of the interventions was uniformly converted to a 4-point grading scale.

RESULTS

Thirty CPGs met the inclusion criteria and were captured as data extraction sources. Most Western medicine (WM) CPGs were developed as EB guidelines. All TCM CPGs and most IM CPGs were identified as CB guidelines. Only the 2011 IBS and IM CPG was a CB-EB set of guidelines. Antispasmodics and peppermint oil for pain, loperamide for diarrhea, and linaclotide for constipation were relatively common in the treatment of IBS. Psyllium bulking agents, polyethylene glycol and lactulose as osmotic laxatives, bisacodyl and sodium picosulfate as stimulant laxatives, lubiprostone and linaclotide as prosecretory agents, and prucalopride were strongly recommended or recommended in FC. TCM interventions were suggested based on pattern differentiation, while the recommendation level was considered to be weak or insufficient.

CONCLUSION

WM CPGs generally provide a comprehensive management algorithm, although there are still some gaps that could be addressed with TCM. Specific high-quality trials are needed to enrich the evidence.

Keywords: Irritable bowel disease; Functional constipation; Clinical practice guideline; Integrative medicine; Systematic review

Core tip: Irritable bowel syndrome (IBS) and functional constipation (FC) are two commonly encountered functional intestinal disorders. Current Western medicine clinical practice guidelines provide relatively complete management algorithms, while there are still gaps that could be filled by traditional Chinese medicine (TCM), such as global symptom alleviation of IBS, interval interventions in FC, and special population solutions. TCM interventions are based on a different medical system and on weak recommendations at present. Future emphasis should be placed on high-quality clinical trial design and implementation to enrich the TCM evidence.