Tags

Type your tag names separated by a space and hit enter

Acupuncture for irritable bowel syndrome: systematic review and meta-analysis.

Abstract

OBJECTIVES

Evidence-based treatment guidelines have been unable to provide evidence-based guidance on the effects of acupuncture for irritable bowel syndrome (IBS) because the only previous systematic review included only small, heterogeneous, and methodologically unsound trials. We conducted a new systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effects of acupuncture for treating IBS.

METHODS

MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Eligible RCTs compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and evaluated acupuncture as an adjuvant to another treatment. Our outcomes were overall IBS symptom severity and health-related quality of life. Dichotomous data were pooled to provide a relative risk (RR) of substantial improvement after treatment, and continuous data were pooled to provide a standardized mean difference (SMD) in post-treatment scores between groups.

RESULTS

A total of 17 RCTs (N=1,806) were included. We found no evidence of an improvement with acupuncture relative to sham acupuncture on symptom severity (SMD=-0.11, 95% confidence interval (95% CI): -0.35 to 0.13; 4 RCTs) or quality of life (SMD=-0.03, 95% CI: -0.27 to 0.22; 3 RCTs). Because of the homogeneity of the results of the sham-controlled trials, results were unaffected by restriction to the four sham-controlled RCTs that used adequate randomization, blinding, and had few withdrawals/dropouts. Among RCTs that did not use a placebo control, acupuncture was more effective than pharmacological therapy (RR of symptom improvement=1.28, 95% CI: 1.12 to 1.45; 5 RCTs) and no (specific) treatment (RR = 2.11, 95% CI: 1.18 to 3.79; 2 RCTs). There was no difference between acupuncture and Bifidobacterium (RR=1.07, 95% CI: 0.90 to 1.27; 2 RCTs) or between acupuncture and psychotherapy (RR=1.05, 95% CI: 0.87 to 1.26; 1 RCT). Acupuncture as an adjuvant to another Chinese medicine treatment was statistically significantly better than the other treatment alone, in trials with a high risk of bias (RR=1.17, 95% CI: 1.02 to 1.33; 4 RCTs).

CONCLUSIONS

Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control on IBS symptom severity or IBS-related quality of life. In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from pharmacological therapies. Future trials may help clarify whether or not these reportedly greater benefits of acupuncture relative to pharmacological therapies are due entirely to patients' preferences for acupuncture or patients' greater expectations of improvement on acupuncture relative to drugs.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, 21201, USA. emanheimer@compmed.umm.edu

    , , , , ,

    Source

    The American journal of gastroenterology 107:6 2012 Jun pg 835-47; quiz 848

    MeSH

    Acupuncture Therapy
    Evidence-Based Medicine
    Gastrointestinal Agents
    Humans
    Irritable Bowel Syndrome
    Quality of Life
    Randomized Controlled Trials as Topic
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    22488079

    Citation

    Manheimer, Eric, et al. "Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-analysis." The American Journal of Gastroenterology, vol. 107, no. 6, 2012, pp. 835-47; quiz 848.
    Manheimer E, Wieland LS, Cheng K, et al. Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2012;107(6):835-47; quiz 848.
    Manheimer, E., Wieland, L. S., Cheng, K., Li, S. M., Shen, X., Berman, B. M., & Lao, L. (2012). Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. The American Journal of Gastroenterology, 107(6), pp. 835-47; quiz 848. doi:10.1038/ajg.2012.66.
    Manheimer E, et al. Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-analysis. Am J Gastroenterol. 2012;107(6):835-47; quiz 848. PubMed PMID: 22488079.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. AU - Manheimer,Eric, AU - Wieland,L Susan, AU - Cheng,Ke, AU - Li,Shih Min, AU - Shen,Xueyong, AU - Berman,Brian M, AU - Lao,Lixing, Y1 - 2012/04/10/ PY - 2012/4/11/entrez PY - 2012/4/11/pubmed PY - 2012/9/7/medline SP - 835-47; quiz 848 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 107 IS - 6 N2 - OBJECTIVES: Evidence-based treatment guidelines have been unable to provide evidence-based guidance on the effects of acupuncture for irritable bowel syndrome (IBS) because the only previous systematic review included only small, heterogeneous, and methodologically unsound trials. We conducted a new systematic review and meta-analysis of randomized controlled trials (RCTs) to estimate the effects of acupuncture for treating IBS. METHODS: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Eligible RCTs compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and evaluated acupuncture as an adjuvant to another treatment. Our outcomes were overall IBS symptom severity and health-related quality of life. Dichotomous data were pooled to provide a relative risk (RR) of substantial improvement after treatment, and continuous data were pooled to provide a standardized mean difference (SMD) in post-treatment scores between groups. RESULTS: A total of 17 RCTs (N=1,806) were included. We found no evidence of an improvement with acupuncture relative to sham acupuncture on symptom severity (SMD=-0.11, 95% confidence interval (95% CI): -0.35 to 0.13; 4 RCTs) or quality of life (SMD=-0.03, 95% CI: -0.27 to 0.22; 3 RCTs). Because of the homogeneity of the results of the sham-controlled trials, results were unaffected by restriction to the four sham-controlled RCTs that used adequate randomization, blinding, and had few withdrawals/dropouts. Among RCTs that did not use a placebo control, acupuncture was more effective than pharmacological therapy (RR of symptom improvement=1.28, 95% CI: 1.12 to 1.45; 5 RCTs) and no (specific) treatment (RR = 2.11, 95% CI: 1.18 to 3.79; 2 RCTs). There was no difference between acupuncture and Bifidobacterium (RR=1.07, 95% CI: 0.90 to 1.27; 2 RCTs) or between acupuncture and psychotherapy (RR=1.05, 95% CI: 0.87 to 1.26; 1 RCT). Acupuncture as an adjuvant to another Chinese medicine treatment was statistically significantly better than the other treatment alone, in trials with a high risk of bias (RR=1.17, 95% CI: 1.02 to 1.33; 4 RCTs). CONCLUSIONS: Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control on IBS symptom severity or IBS-related quality of life. In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from pharmacological therapies. Future trials may help clarify whether or not these reportedly greater benefits of acupuncture relative to pharmacological therapies are due entirely to patients' preferences for acupuncture or patients' greater expectations of improvement on acupuncture relative to drugs. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/22488079/Acupuncture_for_irritable_bowel_syndrome:_systematic_review_and_meta_analysis_ L2 - http://Insights.ovid.com/pubmed?pmid=22488079 DB - PRIME DP - Unbound Medicine ER -