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acupuncture:evaluation:gastro-enterologie:06. syndrome du colon irritable [14 Apr 2025 17:55] Nguyen Johan [1.3.2. Anxiety and depression in irritable bowel syndrome] |
acupuncture:evaluation:gastro-enterologie:06. syndrome du colon irritable [31 May 2025 17:20] (Version actuelle) Nguyen Johan [1.2.1.1. Wang 2025] |
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| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
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| + | === Placebo response === | ||
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| + | == Wang 2025 == | ||
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| + | Wang Z, Chen Y, Li X, Lin L, Chen B, Chen M, Zheng H. Placebo response variability on health-related quality of life outcomes in irritable bowel syndrome: an arm-based network meta-analysis. Qual Life Res. 2025 Jun;34(6):1553-1568. https://doi.org/10.1007/s11136-025-03927- | ||
| + | ^Objectives| The impact of placebo response on health outcomes in various diseases, including IBS, is significant. To better understand the effect of different placebo administration methods on the observed outcomes in IBS studies, this meta-analysis aims to explore research findings on the degree of improvement.| | ||
| + | ^Methods| The meta-analysis included 45 randomized, double-blind, placebo-controlled clinical trials involving 5174 patients with confirmed IBS (excluding those with significant comorbidities). The trials were designed to compare the efficacy of different placebo interventions. The primary outcome was the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), and secondary outcomes included the Irritable Bowel Syndrome Quality of Life Instrument (IBS-QoL) and the IBS Symptom Visual Analog Scale (VAS). An arm-based Bayesian network meta-analysis was performed to examine the relative effectiveness of the placebo interventions on the outcomes.| | ||
| + | ^Results| The analysis revealed that sham moxibustion exhibited the most significant efficacy in reducing IBS-SSS (MD -260.00, 95% CrIs: -288.00 to -232.00). Additionally, sham FMT resulted in significant improvements in IBS-QOL scores (MD 9.23, 95% CrIs - 3.69 to 22.30). Meanwhile, placebo tablet interventions were found to be the most effective in reducing VAS scores (MD 4.71, 95% CrIs, -1.14 to 11.10). Overall, this synthesis provides detailed insights into the effectiveness of placebos in addressing different outcome measures.| | ||
| + | ^Conclusions| Sham moxibustion appears to provide subjective benefits for patients' IBS symptoms. However, the evidence for its efficacy is less robust compared to other interventions, as assessed by GRADE. Understanding the placebo effect in IBS management is crucial for clinical practice and drug development, particularly in placebo comparisons.| | ||
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| + | === Acupoint application === | ||
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| + | == Wang 2025 == | ||
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| + | Wang Q, Zhao L, Liu J, Chen L, Zhang B, Zhang Q, Lu Y, Gao Y, Zheng X, He Z, Jing S. Meta analysis of clinical efficacy of acupoint application in the treatment of irritable bowel syndrome. Afr Health Sci. 2024 Dec;24(4):351-361. https://doi.org/10.4314/ahs.v24i4.44 | ||
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| + | ^ Purpose| The clinical efficacy of acupoint application in the treatment of irritable bowel syndrome (IBS) was evaluated by Meta-analysis.| | ||
| + | ^Method| Computer searched Chinese and English databases for the randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) of TCM external therapy, acupoint application, TCM external application, navel sticking and their combination therapy in the treatment of IBS. The search period is from the establishment of the database to December 2022. The literature was screened independently by 2 researchers according to the standard of nano-ranking, and the data of the other 5 researchers were proofread, screened and extracted. After that, the bias risk of the included study was evaluated, and the data were analysed by RevMan 5.4. software.| | ||
| + | ^Result| (1) A total of 1842 patients, were included in **25 randomized controlled trials**, including the acupoint application treatment group (n=928) and conventional therapy control group (n = 914).(2) The quality of the literature method shows that there are 5 high-quality literatures with a score of 4-7, 20 low-quality literatures with a score of 1-3 and few high-quality literatures;(3) In terms of effectiveness, compared with the western medicine control group, the total odds ratio OR [95 % CI] of the total effective rate of the acupoint application treatment group was 4.77 [3.68, 6.20], and the difference was statistically significant (P < 0.05). Shenque, Zhongwan, Pishu and Zusanli are the most commonly used.(4) In terms of literature bias, 2 studies used envelopes to hide, which belonged to "low risk"; 9 studies were blindly implemented and evaluated as "unclear"; and 6 studies were rated as "high risk" because cases fell off but were not reported. The funnel plot shows that the study is scatter symmetrical, the probability of publication bias is small, and the conclusion is reliable.| | ||
| + | ^Conclusion| Acupoint application can improve the effective clinical rate of IBS with fewer adverse reactions, better patient compliance and fewer adverse reactions, but it still needs to be confirmed by high-quality multicenter, large sample randomized controlled trials.| | ||
| === Moxibustion === | === Moxibustion === | ||
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| ^Results| In this study, **29 RCTs including 3114 participants** for analysis (treatment group, 1730; control group, 1384) were included. Compared to other therapies, acupuncture significantly improved the quality of life (SMD = 0.61, 95% CI = [0.26, 0.96], P < 0.001) and alleviated anxiety (SMD = - 0.72, 95% CI = [- 1.76, 0.32], P = 0.18) and depression (SMD = - 0.74, 95% CI = [- 1.18, - 0.3], P < 0.001) in IBS patients. A statistically significant improvement was recorded in their quality of life, and they also displayed fewer symptoms of depression. The total response rate (RR = 1.18, 95% CI = [1.12, 1.25], P < 0.001) indicated that acupuncture significantly affected IBS treatment in comparison to other methods. Subgroup analysis of primary outcome indicators revealed that acupuncture demonstrated better results regardless of the duration of intervention and was more effective than Western medicine or sham acupuncture. In addition to the total response rate (I2 = 0%), the other three outcome indicators showed significant heterogeneity (I2 > 50%). No publication bias was noted in RR (P < 0.05); however, a significant publication bias was observed in quality of life (P > 0.05).| | ^Results| In this study, **29 RCTs including 3114 participants** for analysis (treatment group, 1730; control group, 1384) were included. Compared to other therapies, acupuncture significantly improved the quality of life (SMD = 0.61, 95% CI = [0.26, 0.96], P < 0.001) and alleviated anxiety (SMD = - 0.72, 95% CI = [- 1.76, 0.32], P = 0.18) and depression (SMD = - 0.74, 95% CI = [- 1.18, - 0.3], P < 0.001) in IBS patients. A statistically significant improvement was recorded in their quality of life, and they also displayed fewer symptoms of depression. The total response rate (RR = 1.18, 95% CI = [1.12, 1.25], P < 0.001) indicated that acupuncture significantly affected IBS treatment in comparison to other methods. Subgroup analysis of primary outcome indicators revealed that acupuncture demonstrated better results regardless of the duration of intervention and was more effective than Western medicine or sham acupuncture. In addition to the total response rate (I2 = 0%), the other three outcome indicators showed significant heterogeneity (I2 > 50%). No publication bias was noted in RR (P < 0.05); however, a significant publication bias was observed in quality of life (P > 0.05).| | ||
| ^Conclusion| Acupuncture can enhance the quality of life and relieve anxiety and depression in patients with IBS with apparent safety; however, a large number of high-quality RCTs are still needed.| | ^Conclusion| Acupuncture can enhance the quality of life and relieve anxiety and depression in patients with IBS with apparent safety; however, a large number of high-quality RCTs are still needed.| | ||
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| + | == Hou 2024 == | ||
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| + | Hou Y, Chang X, Liu N, Wang Z, Wang Z, Chen S. Different acupuncture and moxibustion therapies in the treatment of IBS-D with anxiety and depression: A network meta-analysis. Medicine (Baltimore). 2024 Apr 26;103(17):e37982. https://doi.org/10.1097/MD.0000000000037982 | ||
| + | ^Backgound| Currently, a variety of Western medical interventions are available for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) with comorbid anxiety and depression. However, the attendant negative effects also emerge, putting pressure on healthcare resources and socio-economic structures. In recent years, the benefits of acupuncture (ACU) and moxibustion in the treatment of IBS-D with anxiety and depression have gradually emerged. However, there are many types of ACU-moxibustion-related treatments, and the aim of this study is to examine the effectiveness of different ACU-moxibustion therapies in the treatment of anxiety and depression in IBS-D patients.| | ||
| + | ^Methods| Searched and identified randomized controlled trials (RCTS) of ACU for the treatment of anxiety and depression in patients with irritable bowel syndrome (IBS). The search spanned from the establishment of the database until September 1, 2023. Revman 5.4 and Stata 15.0 software were used for network meta-analysis (NMA), and the included interventions were ranked by the area under the cumulative ranking curve.| | ||
| + | ^Results| A total of **26 articles** involving 8 interventions were included. In terms of improving HAMA score, MOX was superior to EA, combined therapies, CH, WM and placebo; In terms of improving HAMD score, MOX was superior to ACU, EA, combined therapies, WM and placebo; In terms of improving the SAS score, The combined therapies were superior to EA, CH and WM; In terms of improving SDS scores, The combined therapies were superior to EA, CH and WM; In terms of improving IBS-SSS score, The combined therapies were superior to WM; In terms of reducing recurrence rates, CH was superior to combined therapies; In terms of improving total effective rates, MOX was superior to EA, CH, WM and placebo; MOX, combined therapies, ACU and EA ranked higher in SUCRA of different outcome indicators.| | ||
| + | ^Conclusion| MOX, combined therapies, ACU and EA have certain curative effect on anxiety and depression in patients with IBS-D, and their safety is high. ACU and MOX combined with other therapies also have significant advantages in the treatment effect.| | ||
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| + | == Wang 2024 == | ||
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| + | Wang Z, Hou Y, Sun H, Wang Z, Zhang H. Efficacy of acupuncture treatment for diarrhea-predominant irritable bowel syndrome with comorbid anxiety and depression: A meta-analysis and systematic review. Medicine (Baltimore). 2024 Nov 15;103(46):e40207. https://doi.org/10.1097/MD.0000000000040207 | ||
| + | ^Backgound| Presently, a diverse range of Western medical interventions are accessible for the management of irritable bowel syndrome with diarrhea (IBS-D) concomitant with comorbid anxiety and depression. However, the concomitant adverse effects have also surfaced, exerting strain on healthcare resources and the socio-economic structure. In recent times, the benefits of acupuncture in the management of IBS-D with coexisting anxiety and depression have become progressively evident. Nevertheless, a paucity of evidence-based medicine exists to substantiate the utilization of acupuncture for the treatment of IBS-D with anxiety and depression. The objective of this study is to examine the effectiveness of acupuncture as an intervention for IBS-D with comorbid anxiety and depression.| | ||
| + | ^Methods| We searched 7 databases, including the Chinese Journal Full-text Database, Wanfang Academic Journals Full-text Database, VIP Chinese Scientific Journals Full-text Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) related to acupuncture treatment for IBS with anxiety and depression, published from database inception to August 1, 2023. RevMan 5.4 and Stata 17.0 software were used for meta-analysis of relevant outcome measures.| | ||
| + | ^Results| This study included a total of **16 RCTs, involving 1305 IBS-D patients** (691 in the experimental group and 614 in the control group). The meta-analysis results showed that compared to oral medication, acupuncture therapy improved HAMD scores (MD = 0.88, 95% CI = [0.68, 1.07], P < .00001), HAMA scores (MD = 2.32, 95% CI = [1.70, 2.93], P < .00001), self-rating anxiety scale scores (MD = 11.67, 95% CI = [10.85, 12.49], P < .00001), SDS scores (MD = 9.84, 95% CI = [8.52, 11.16], P < .00001), IBS-SSS scores (MD = 37.48, 95% CI = [12.17, 62.78], P = .004), overall response rate (MD = 1.27, 95% CI = [1.20, 1.35], P < .00001), and relapse rate (MD = 0.27, 95% CI = [0.16, 0.47], P < .00001) in patients with IBS-D comorbid with anxiety and depression.| | ||
| + | ^Conclusion| Acupuncture treatment has a definite and beneficial effect on IBS-D patients with comorbid anxiety and depression.| | ||
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| ===== Clinical Practice Guidelines ===== | ===== Clinical Practice Guidelines ===== | ||
| | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
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| + | ==== European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN and NASPGHAN) 2025 Ø==== | ||
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| + | Groen J, Gordon M, Chogle A, Benninga M, Borlack R, Borrelli O, Darbari A, Dolinsek J, Khlevner J, Di Lorenzo C, Person H, Sanghavi R, Snyder J, Thapar N, Vlieger A, Sinopoulou V, Tabbers M, Saps M. ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4-18 years. J Pediatr Gastroenterol Nutr. 2025 May 30. https://doi.org/10.1002/jpn3.70070 | ||
| + | | **children aged 4-18 years**. All of the following therapies were therefore not suggested as treatment options. **Acupuncture**…| | ||
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