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Syndrome du colon irritable : évaluation de l'acupuncture

Articles connexes: - traitement par acupuncture - Acupuncture expérimentale -

5. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
☆ Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

5.1. Generic Acupuncture

5.1.1. Billing 2020

Billings W, Mathur K, Craven HJ, Xu H, Shin A. Potential Benefit with Complementary and Alternative Medicine in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020;3565(20):31296-9. [212417]. doi

Background and aims Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS.
Methods Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed.
Results Among 2825 articles identified, 66 were included. Herbal therapy (SMD=0.47, 95% CI: 0.20 to 0.75, I2=82%) demonstrated significant benefit over placebo for abdominal pain (low confidence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD=0.29, 95% CI: -0.01 to 0.59, I2=78%). Herbal therapy (RR=1.57, 95% CI: 1.31 to 1.88, I2=77%), dietary supplements (RR=1.95, 95% CI: 1.02 to 3.73, I2=75%), and mind-body based therapy (RR=1.67, 95% CI: 1.13 to 2.49, I2=63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies [acupuncture included 4RCTs] demonstrated no significant benefit over placebo or sham for abdominal pain or overall response.
Conclusion CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.

5.1.2. Zheng 2019

Zheng H, Chen R, Zhao X, Li G, Liang Y, Zhang H, Chi Z. Comparison between the Effects of Acupuncture Relative to Other Controls on Irritable Bowel Syndrome: A Meta-Analysis. Pain Res Manag. 2019. [203243].

BackgroundIrritable bowel syndrome (IBS) is a functional gastrointestinal disorder with recurrent abdominal pain and altered defecation habits. We here attempted to determine the effect of acupuncture on IBS.
MethodsRandomized controlled trials (RCTs) published in CNKI, VIP, Wanfang, PubMed, Cochrane Library, EMBASE, Web of science, and ClinicalTrials.gov till July 17, 2019 were searched. Outcomes were total efficacy rates, overall IBS symptom scores, or global quality of life scores. Standardized mean difference (SMD) with 95% confidence intervals (CI) and risk ratio (RR) with 95% CI were calculated for meta-analysis.
Results We included 41 RCTs involving 3440 participants for analysis. 8 RCTs compared acupuncture with sham acupuncture, among which 3 trials confirmed the biological effects of acupuncture, especially in treating abdominal pain, discomfort, and stool frequency. No significant difference was found when acupuncture was compared with sham acupuncture, in terms of effects on IBS symptoms and quality of life (SMD = 0.18, 95% CI -0.26∼0.63, P=0.42; SMD = -0.10, 95% CI -0.31∼0.11, P=0.35), but the pooled efficacy rate data showed a better outcome for true acupuncture (RR = 1.22, 95% CI 1.01∼1.47, P=0.04), which was not supported by sensitivity analysis. Acupuncture was more effective relative to western medicine in alleviating IBS symptoms (RR = 1.17, 95% CI 1.12∼1.23, I 2 = 0%, P < 0.00001), whose effect might last 3 months. Besides, acupuncture as an adjunct to western medicine, Chinese medications, or tuina was superior over the single latter treatment (RR = 1.68, 95% CI 1.18 to 2.40, P=0.004; 1.19, 1.03 to 1.36, P=0.02; 1.36, 1.08 to 1.72, P=0.009, respectively), with high heterogeneities.
ConclusionsRelative to sham controls, acupuncture showed no superiority for treating IBS, while the advantage over western medicine was significant. Acupuncture could be used as an adjunct in clinical settings to improve efficacy. Future high-quality and large-sample-size studies with adequate quantity-effect design need to be conducted.

5.1.3. Fu 2018

Fu Chengwei, Jiang Wei. [The Effect of Acupuncture Therapy on Irritable Bowel Syndrome: a meta-analysis]. Asia-Pacific Traditional Medicine. 2018;12:101-105. [201742].

Objective To systematically compare the effect of acupuncture with pinaverium on irritable bowel syndrome.
MethodsGet together clinical randomized controlled trials of acupuncture therapy for IBS. Database of China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),VIP Database, Wanfang data library, and English database PubMed, Cochrane Library, Web of Science. Randomized controlled clinical trials of acupuncture therapy or give priority to acupuncture therapy in the treatment of IBS, bias risk and quality assessment for each inclusion test was conducted by two researchers in accordance with the JADAD score and the Cochrane Handbook 5.1.0 standard, Meta-analysis was performed with Rev.Man 5.3 software.
ResultsEleven studies involving 1685 patients were enrolled, of whom 864 were treated with acupuncture therapy, and 821 patients were treated with pinaverium alone. The result of meta-analysis shows that acupuncture combined with moxibustion was superior to conventional western medicine in the effective RR=1.20,95%CI[1.15～1.25]>1.
ConclusionAcupuncture therapy is superior to conventional pinaverium in the treatment of IBS.

5.1.4. Chao 2014 ☆☆

Chao GQ, Zhang S. Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2014;20(7):1871-7. [170907]. IF: 2.369

Aim To evaluate the efficacy of acupuncture for treatment of irritable bowel syndrome (IBS) through meta-analysis of randomized controlled trials.
Methods We searched MEDLIINE, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from 1966 to February 2013 for double-blind, placebo-controlled trials investigating the efficacy of acupuncture in the management of IBS. Studies were screened for inclusion based on randomization, controls, and measurable outcomes reported. We used the modified Jadad score for assessing the quality of the articles. STATA 11.0 and Revman 5.0 were used for meta-analysis. Publication bias was assessed by Begg's and Egger's tests.
Results Six randomized, placebo-controlled clinical trials met the criteria and were included in the meta-analysis. The modified Jadad score of the articles was > 3, and five articles were of high quality. We analyzed the heterogeneity and found that these studies did not cause heterogeneity in our meta-analysis. Begg's test showed P = 0.707 and Egger's test showed P = 0.334. There was no publication bias in our meta-analysis (Begg's test, P = 0.707; Egger's test, P = 0.334). From the forest plot, the diamond was on the right side of the vertical line and did not intersect with the line. The pooled relative risk for clinical improvement with acupuncture was 1.75 (95%CI: 1.24-2.46, P = 0.001). Using the two different systems of STATA 11.0 and Revman 5.0, we confirmed the significant efficacy of acupuncture for treating IBS.
Conclusion Acupuncture exhibits clinically and statistically significant control of IBS symptoms.

5.1.5. Pei 2012 ☆☆

Pei LX, Zhang XC, Sun JH, Geng H, Wu XL. [Meta analysis of acupuncture-moxibustion in treatment of irritable bowel syndrome]. Chinese Acupuncture and Moxibustion. 2012;32(10):957-60.[162036]

Purpose To evaluate the clinical efficacy and safety of acupuncture-moxibuation in treatment of irritable howel syndrome systematically
Methods Clinical randomized controlled trials on treatment of irritable bowel syndrome with acupuncture；moxibustion were collected. Through retrieval of CNKI（1979 一December of 2011 ) and VIP (1979一December of 2011), randomized and quasi-randomized controlled clinical trials on treatment of irritable bowel syndrome with control study between acupuncture and sham acupuncture or western medication were included. The test bias risk and quality assessment of each experiment were carried out by two researchers in accordance with the Cochrane Handbook 5.1.0 standard. And RevMan 5.1.6 software was adopted for the Meta analysis.
Results Eleven researches were included with totally 969 patients. Meta analysis shows that the effective rate of the combined methods of acupuncture and moxibustion [RR=1. 27,95% CI(1. 09,1. 49)]is superior to conventional western medication treatment.
Conclusion Acupuncture-moxibustion for irritable bowel syndrome is better than the conventional western medication treatment.

5.1.6. Manheimer 2012 ☆☆

Manheimer E, Wieland LS, Cheng K, Li SM, Shen X, Berman BM, Lao L.. Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis. AM J Gastroenterol. 2012; 107(6):835-47. [160301].

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.

5.1.7. Manheimer 2012 ☆☆

Manheimer E, Cheng K, Wieland LS, Min LS, Shen X, Berman BM, Lao L.. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2012;5:CD005111. doi: 10.1002/14651858.CD005111.pub3.[160292]. IF: 6.032.

Purpose The primary objectives were to assess the efficacy and safety of acupuncture for treating IBS.
Methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and RCTs that evaluated acupuncture as an adjuvant to another treatment, in adults with IBS were included. Two authors independently assessed the risk of bias and extracted data.We extracted data for the outcomes overall IBS symptom severity and health-related quality of life. For dichotomous data (e.g. the IBS Adequate Relief Question), we calculated a pooled relative risk (RR) and 95% confidence interval (CI) for substantial improvement in symptom severity after treatment. For continuous data (e.g. the IBS Severity Scoring System), we calculated the standardized mean difference (SMD) and 95% CI in post-treatment scores between groups.
Results Seventeen RCTs (1806 participants) were included. Five RCTs compared acupuncture versus sham acupuncture. The risk of bias in these studies was low.We found no evidence of an improvement with acupuncture relative to sham (placebo) acupuncture for symptom severity (SMD-0.11, 95%CI -0.35 to 0.13; 4 RCTs; 281 patients) or quality of life (SMD = -0.03, 95%CI -0.27 to 0.22; 3 RCTs; 253 patients). Sensitivity analyses based on study quality did not change the results. A GRADE analysis indicated that the overall quality of the evidence for the primary outcomes in the sham controlled trials was moderate due to sparse data. The risk of bias in the four Chinese language comparative effectiveness trials that compared acupuncture with drug treatment was high due to lack of blinding. The risk of bias in the other studies that did not use a sham control was high due to lack of blinding or inadequate methods used for randomization and allocation concealment or both. Acupuncture was significantly more effective than pharmacological therapy and no specific treatment. Eighty-four per cent of patients in the acupuncture group had improvement in symptom severity compared to 63% of patients in the pharmacological treatment group (RR 1.28, 95% CI 1.12 to 1.45; 5 studies, 449 patients). A GRADE analysis indicated that the overall quality of the evidence for this outcome was low due to a high risk of bias (no blinding) and sparse data. Sixty-three per cent of patients in the acupuncture group had improvement in symptom severity compared to 34% of patients in the no specific therapy group (RR 2.11, 95% CI 1.18 to 3.79; 2 studies, 181 patients). There was no statistically significant difference between acupuncture and Bifidobacterium (RR 1.07, 95% CI 0.90 to 1.27; 2 studies; 181 patients) or between acupuncture and psychotherapy (RR 1.05, 95% CI 0.87 to 1.26; 1 study; 100 patients). Acupuncture as an adjuvant to another Chinese médicine treatment was significantly better than the other treatment alone. Ninety-three per cent of patients in the adjuvant acupuncture group improved compared to 79% of patients who received Chinese medicine alone (RR 1.17, 95% CI 1.02 to 1.33; 4 studies; 466 patients). There was one adverse event (i.e. acupuncture syncope) associated with acupuncture in the 9 trials that reported this outcome, although relatively small sample sizes limit the usefulness of these safety data.
Conclusion Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life. In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from two antispasmodic drugs (pinaverium bromide and trimebutine maleate), both of which have been shown to provide a modest benefit for IBS. 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 greater expectations of improvement on acupuncture relative to drug therapy.

5.1.8. Zhao 2010 ☆☆

Zhao Chen, Mu Jing-Ping, Cui Yun-Hua, Yang Ling, Ma Xiao-Peng, Qi Li. [Meta-analysis on acupuncture and moxibustion for irritable bowel syndrome]. Chinese Archives of Traditional Chinese Medicine. 2010;5:961-963. [186931].

Objectives To summarize the effectiveness of acupuncture and moxibustion as a therapy for Irritable Bowel Syndrome (IBS).
Methods RCTs were included, in which trials of acupuncture and moxibustion as a therapy for IBS in recent 10 years were extracted by computer and manual searching, for Meta-analyse. The methodological quality was assessed in accordance with the principles of EBM.
Results The fixed effect model was to be used and the tests for heterogeneity shows that there were no significant differences (χ2=9. 32, P=0. 41, P>0. 05 ), which means the effectsizes of the trials were homogeneous. We combined and estimated two groups’ effectsizes, RR=1. 28, (95% CI-1. 20 to 1. 38). Z test showed that the therapeutic effect of two groups were have significant differences (Z= 7. 143, P<0. 00001), and the rhombus was located at the right side of the medium line.
Conclusions The therapeutic effect of acupuncture and moxibustion on Irritable Bowel Syndrome is superior to that of western medicine.

5.1.9. Shen 2009 Ø

Shen YH, Nahas R. Complementary and Alternative Medicine for Treatment of Irritable Bowel Syndrome. Can Fam Physician. 2009;55(2):143-8. [153146].

Objectives To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS).
Methods QUALITY OF EVIDENCE: MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions.
Results Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses.
Conclusions Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.
Acupuncture Acupuncture might be beneficial for some patients with IBS, but current evidence does not support its use.

5.1.10. Lim 2006 ☆

Lim B, Manheimer E, Lao L, Ziea E,Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005111. DOI: 10.1002/14651858.CD005111.pub2.[141480]

Purpose The objective of this systematic review is to determine whether acupuncture is more effective than no treatment, more effective than ’sham’ (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. Adverse events associated with acupuncture were also assessed.
Methods The following electronic bibliographic databases were searched irrespective of language, date of publication, and publication status:MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to Nursing and Allied Health (CINAHL), and the Allied and Complementary Médicine Database (AMED). References in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February 2006. Published reports of randomized controlled trials (RCTs) and quasi-randomised trials of acupuncture therapy for IBS. All eligible records identified were dually evaluated for eligibility and dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity Scale. Data from individual trials were combined formeta-analysis when the interventions were sufficiently similar.Heterogeneity was assessed using the I squared statistic.
Results Six trials were included. The proportion of responders, as assessed by either the global symptomscore or the patient-determined treatment success rate, did not show a significant difference between the acupuncture and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98;n=109). Acupuncture treatment was also not significantly more effective than sham acupuncture for overall general well-being, individual symptoms (e.g., abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI 1.00 to 1.31;n=132);acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to 1.39;n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of 1.49(95% CI 0.94 to 2.34;n=48).
Conclusion Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.

5.1.11. Hussain 2006 Ø

Hussain Z, Quigley EM. Systematic Review: Complementary and Alternative Medicine in the Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2006;23(4):465-71. [141341].

Objectives Complementary and alternative medical therapies and practices are widely employed in the treatment of the irritable bowel syndrome. AIM: To review the usage of complementary and alternative medicine in the irritable bowel syndrome, and to assess critically the basis and evidence for its use.
Methods A systematic review of complementary and alternative medical therapies and practices in the irritable bowel syndrome was performed based on literature obtained through a Medline search.
Results A wide variety of complementary and alternative medical practices and therapies are commonly employed by irritable bowel syndrome patients both in conjunction with and in lieu of conventional therapies. As many of these therapies have not been subjected to controlled clinical trials, some, at least, of their efficacy may reflect the high-placebo response rate that is characteristic of irritable bowel syndrome. Of those that have been subjected to clinical trials most have involved small poor quality studies. There is, however, evidence to support efficacy for hypnotherapy, some forms of herbal therapy and certain probiotics in irritable bowel syndrome.
Conclusions Doctors caring for irritable bowel syndrome patients need to recognize the near ubiquity of complementary and alternative medical use among this population and the basis for its use. All complementary and alternative medicine is not the same and some, such as hypnotherapy, forms of herbal therapy, specific diets and probiotics, may well have efficacy in irritable bowel syndrome. Above all, we need more science and more controlled studies; the absence of truly randomized placebo-controlled trials for many of these therapies has limited meaningful progress in this area.
Acupuncture No benefit over sham (1 RCT)

5.2. Techniques particulières

5.2.1. Moxibustion

5.2.1.1. Tang 2016 ☆

Tang B, Zhang J, Yang Z, Lu Y, Xu Q, Chen X, Lin J. Moxibustion for Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med. 2016. [186285].

Background The complementary and alternative medicines in treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) are controversial.
Methods We searched PubMed, Ovid Embase, Web of Science, Cochrane Library databases, CNKI, Wanfang Database, CBM, VIP, and AMED for randomized controlled trials (RCTs) of moxibustion compared with pharmacological medications in patients with IBS-D. A meta-analysis was performed using both fixed and random-effects models based on heterogeneity across studies.
Results In total, 568 patients in 7 randomized controlled trials were randomly treated with moxibustion and pharmacological medications. The improvement of global IBS-D symptoms and overall scores was significant (P = 0.0001 and P < 0.0001, resp.) in patients treated by moxibustion only compared to pharmacological medications. The specific IBS-D symptoms of abdominal pain, abdominal distension, abnormal stool, and defecation frequency were alleviated in patients treated by moxibustion compared to pharmacological medications, but no significance was found except for abdominal distension and defecation frequency (P = 0.03 and P = 0.02, resp.). There were no serious adverse events related to moxibustion.
Conclusions Moxibustion appears to be effective in treating IBS-D compared with pharmacological medications. However, further large, rigorously designed trials are warranted due to insufficient methodological rigor in the included trials.
5.2.1.2. Park 2013 ☆

Park JW, Lee BH, Lee H. Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis. BMC Complement Altern Med. 2013;13:247. doi: 10.1186/1472-6882-13-247. [168397]

Purpose This systematic review and meta-analysis aimed at critically evaluating the current evidence on moxibustion for improving global symptoms of Irritable bowel syndrome (IBS).
Methods We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, CINAHL, and CNKI databases for randomised controlled trials (RCTs) of moxibustion comparing with sham moxibustion,pharmacological medications, and other active treatments in patients with IBS. Trials should report global symptom improvement as an outcome measure. Risk of bias for each RCT was assessed according to criteria by the Cochrane Collaboration, and the dichotomous data were pooled according to the control intervention to obtain a risk ratio (RR) of global symptom improvement after moxibustion, with 95% confidence intervals (CI).
Results A total of 20 RCTs were eligible for inclusion (n = 1625). The risk of bias was generally high. Compared with pharmacological medications, moxibustion significantly alleviated overall IBS symptoms but there was a moderate inconsistency among studies (7 RCTs, RR 1.33, 95% CI [1.15, 1.55], I2 = 46%). Moxibustion combined with acupuncture was more effective than pharmacological therapy but a moderate inconsistency among studies was found (4 RCTs, RR 1.24, 95% CI [1.09, 1.41], I2 = 36%). When moxibustion was added to pharmacological médications or herbal medicine, no additive benefit of moxibustion was shown compared with pharmacological medications or herbal medicine alone. One small sham-controlled trial found no difference between moxibustion and sham control in symptom severity (mean difference 0.35, 95% CI [−0.77, 1.47]). Moxibustion appears to be associated with few adverse events but the evidence is limited due to poor reporting.
Conclusion This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high.

5.2.2. Association à la phytothérapie chinoise

5.2.2.1. Yan 2019 ★

Yan J, Miao ZW, Lu J, Ge F, Yu LH, Shang WB, Liu LN, Sun ZG. Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2019. [197596].

PURPOSETo comprehensively evaluate the efficacy and safety of acupuncture combined with Chinese herbal medicine (CHM) in treating irritable bowel syndrome with diarrhea (IBS-D).
METHODS Relevant randomized controlled trials (RCTs) were systemically retrieved from electronic databases from inception to March 2018, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical Database (CBM, SinoMed), China Science and Technology Journal Database (VIP), and Wan Fang Data. Meanwhile, pooled estimates, including the 95% confidence interval (CI), were calculated for primary and secondary outcomes of IBS-D patients. Besides, quality of relevant articles was evaluated using the Cochrane Collaboration's risk of bias tool, and the Review Manager 5.3 and Stata12.0 softwares were employed for analyses.
RESULTSA total of 21 RCTs related to IBS-D were included into this meta-analysis. Specifically, the pooled results indicated that (1) acupuncture combined with CHM might result in more favorable improvements compared with the control group (relative risk [RR] 1.29; 95% CI 1.24-1.35; P =0.03); (2) the combined method could markedly enhance the clinical efficacy in the meantime of remarkably reducing the scores of abdominal pain (standardized mean difference [SMD] -0.45; 95% CI -0.72, -0.17; P = 0.002), abdominal distention/discomfort (SMD -0.36; 95% CI -0.71, -0.01; P = 0.04), diarrhea (SMD -0.97; 95% CI -1.18, -0.75; P < 0.00001), diet condition (SMD -0.73; 95% CI -0.93, -0.52; P<0.00001), physical strength (SMD -1.25; 95% CI -2.32, -0.19; P = 0.02), and sleep quality (SMD -1.02; 95% CI -1.26, -0.77; P < 0.00001) compared with those in the matched groups treated with western medicine, or western medicine combined with CHM. Additionally, a metaregression analysis was constructed according to the name of prescription, acupuncture type, treatment course and publication year, and subgroup analyses stratified based on the names of prescriptions and acupoints location were also carried out, so as to explore the potential heterogeneities; and (3) IBS-D patients treated with the combined method only developed inconspicuous adverse events; more importantly, the combined treatment had displayed promising long-term efficacy.
CONCLUSIONSFindings in this study indicate that acupuncture combined with CHM is suggestive of an effective and safe treatment approach for IBS-D patients, which may serve as a promising method to treat IBS-D in practical application. However, more large-scale, multicenter, long-term, and high-quality RCTs are required in the future, given the small size, low quality, and high risk of the studies identified in this meta-analysis.

5.3. Principes thérapeutiques

5.3.1. Dispersion du Foie et tonification de la Rate

5.3.1.1. Li 2016 ☆☆

Li Xiang-li, Liao Jian-qiong, Cai Jing-zhou, Wang Sheng-xu. [Clinically Randomized Control Trials of Liver Dispersing with Spleen Strengthening for Irritable Bowel Syndrome Dominated by Diarrhea: A Meta-analysis]. Journal of Clinical Acupuncture and Moxibustion. 2016;32(4):49-53. [182275].

ObjectiveThe clinically therapeutic effect of liver dispersing with spleen strengthening for irritable bowel syndrome by diarrhea was systematically analyzed to provide reference and assistance for its clinical treatment and research.
Methods By searching in the Cochrane Library, PubMed, Embase, CNKI, Wangfang, vIP, CBM, clinically randomized controlled trials (RCT) of liver dispersing with spleen strengthening for irritable bowel syndrome by diarrhea published from inception to April 2015 were collected while Revman 5. 2 software was applied to perform the Meta - analysis. Results: Ten studies involving 78 1 participants were included in our Meta - analysis.
ResultsThe results showed that liver dispersing with spleen strengthening (herbs, Chinese patent drug, acupuncture) had an advantage over western medicine in the treatment of IBS - D [ total efficacy: OR = 3. 94, 95 % CI (2. 58 - 6. 0 1), P< 0. 0 1 〕, and the symptoms of abdominal pain, abdominal distention and stool consistency were relieved, but the mental symptom was not significantly relieved.
ConclusionLiver dispersing with spleen strengthening (herbs, Chinese patent drug, acupuncture) is effective for IBS - D patients in relieving clinical symptoms, especially in the symptoms of abdominal pain, abdominal distention and stool consistency. It is safe and there is no serious adverse reaction.

5.4. Formes cliniques particulières

5.4.1. Deng 2017 (forme diarrhéique) ☆☆

Deng D, Guo K, Tan J1, Huang G, Li S, Jiang Q, Xie J, Xie H, Zhang Z, Chen Y, Peng L. [Acupuncture for diarrhea-predominant irritable bowel syndrome: a meta-analysis]. Zhongguo Zhen Jiu. 2017;37(8):907-912. [43743].

ObjectiveTo systematically evaluate the efficacy and safety of acupuncture on diarrhea-predominant irritable bowel syndrome (IBS) in the past five years.
MethodsOnline databases, including CNKI, VIP, WANFANG, PubMed, CBM, ScienceDirect OnSite, Cochrane Library, etc. were searched for randomized controlled trials (RCTs) of acupuncture for diarrhea-predominant IBS. Retrieval time was from January of 2011 to January of 2016. According to modified Jadad standard, the bias risk and quality assessment of each RCT included were evaluated by two researchers. RevMan 5.3 software was adopted for the meta-analysis.
ResultsTotally 17 RCTs were included with 1 333 patients. The result of meta-analysis indicated the total effective rate of clinical symptoms improvement in the acupuncture group or acupuncture combined with western medicine group was superior to that in the western medicine group (OR=3.92, 95% CI:2.83~5.43, P<0.01), and the funnel plot was basically symmetry. The result of meta-analysis showed 3-month recurrence rate: OR=0.22, 95% CI:0.12~0.41 (P<0.01), indicating the recurrence rate in the acupuncture group was lower than that in the western medicine group in three months.
Conclusions Acupuncture for diarrhea-predominant irritable bowel syndrome is superior to conventional treatment of western medication, which can improve the clinical symptoms and reduce the recurrence rate of patients.

5.5. Références des essais inclus

a = Chao 2014
b = Park 2013
c = Pei 2012
d = Manheimer 2012
e = Lim 2006

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6. Revues de revues systématiques et méta-analyses

6.1. Wu 2019 ☆

Wu IXY , Wong CHL , Ho RST , Cheung WKW , Ford AC , Wu JCY , Mak ADP , Cramer H , Chung VCH. Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis. Therap Adv Gastroenterol. 2019. [192630].

Background An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other irritable bowel syndrome (IBS) treatments.
Methods A total of eight international and Chinese databases were searched for SRs of randomized controlled trials (RCTs). The methodological quality of SRs was appraised using the AMSTAR instrument. From the included SRs, data from RCTs were extracted for the random-effect pairwise meta-analyses. An NMA was used to evaluate the comparative effectiveness of different treatment options. The risk of bias among included RCTs was assessed using the Cochrane risk of bias tool.
Results From 15 SRs of mediocre quality, 27 eligible RCTs (n = 2141) were included but none performed proper blinding. Results from pairwise meta-analysis showed that both needle acupuncture and electroacupuncture were superior in improving global IBS symptoms when compared with pinaverium bromide. NMA results showed needle acupuncture plus Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options, but a slight inconsistency exists.
ConclusionThe risk of bias and NMA inconsistency among included trials limited the trustworthiness of the conclusion. Patients who did not respond well to first-line conventional therapies or antidepressants may consider acupuncture as an alternative. Future trials should investigate the potential of (1) acupuncture as an add-on to antidepressants and (2) the combined effect of Chinese herbs and acupuncture, which is the norm of routine Chinese medicine practice.

6.2. Zhang 2014 ☆

Wei Zhang, Jian-Hua Sun, Li-Xia Pei, Xiao-Liang Wu, Jun-Ling Zhou, Lu Chen,. [Traditional chinese medicine for treatment of irritable bowel syndrome: an overview of systematic reviews and metaanalyses]. World Chinese Journal of Digestology. 2014;12:1747-175. [187063].

Objectives To evaluate the relevant systematic reviews/meta-analyses that focused on the traditional Chinese medicine (TCM) for treatment of irritable bowel syndrome (IBS).
Methods Databases including Cochrane Library, PubMed, AMED, Embase, CBM, CNKI, VIP and WanFang Data were searched from inception to November 2013 to collect the systematic reviews/meta-analyses that focused on the TCM for IBS. Two reviewers screened the literature according to the inclusion criteria and extracted the data. The AMSTAR was used to evaluate the quality of the included studies, and the GRADE system was used to evaluate the quality of evidence.
Results A total of 14 relevant systematic reviews/meta-analyses were included, of which 10 evaluated the efficacy of Chinese herbal medicine and 4 evaluated acupuncture and Moxibustion. AMSTAR scores were between 2 and 10 points. The results showed that TCM has advantage over conventional medicine in the treatment of IBS; however, the evidence quality is low.
Conclusions This research can provide some references for TCM treatment of IBS. Based on the quality level of GRADE evidence, the evidence user should make an evidence-based decision according to the real condition. TCM clinical research should, based on its own characteristics, select the appropriate research design methods, further develop high-quality clinical studies for the evaluation of Chinese medicine treatment of IBS and provide the high-quality evidence.

7. Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

7.1. Canadian Association of Gastroenterology 2019 Ø

Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG0, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol. 2019;2(1):6-29. [197158].

15: We recommend AGAINST offering acupuncture to IBS patients to improve IBS symptoms. GRADE: Strong recommendation, very low-quality evidence.

7.2. British Society of Gastroenterology 2018 Ø

Lamb CA, Kennedy NA, Raine T, Hendy P, Smith PJ, Limdi JK et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. British Society of Gastroenterology. 2018;:386p. [197080].

Anecdotical evidence supports the use of acupuncture although there are no controlled trials and in this case blinding is an obvious problem.

7.3. Sociedad Española de Patología Digestiva (SEPD, Espagne) 2016 Ø

Mearin F, Ciriza C, Mínguez M, Rey E, Mascort JJ, Peña E, Cañones P, Júdez J. Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult. Rev Esp Enferm Dig. 2016;108(6):332-63. [98987].

No evidence supports recommending acupuncture to improve symptoms or quality of life in patients with IBS-C or FC.

7.4. World Gastroenterology Organisation (WGO) 2015 Ø

Irritable Bowel Syndrome: a Global Perspective World Gastroenterology Organisation. 2015:28p. [196753].

A systematic review of trials of acupuncture was inconclusive due to heterogeneous outcomes. Further research is needed before any recommendations on acupuncture or herbal therapy can be made.

7.5. National Institute for Health and Care Excellence (NICE, UK) 2015 Ø

National Collaborating Centre for Nursing and Supportive Care. Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. London (UK): National Institute for Health and Care Excellence (NICE). 2015;37P. [165730].

The use of acupuncture should not be encouraged for the treatment of IBS.[2008]

7.6. World Gastroenterology Organisation (WGO) 2009 Ø

WGO Global Guideline; Syndrome de l’intestin irritable : Une approche globale World Gastroenterology Organisation Global Guidelines. 2009. 26P. [178703].

Une revue systématique des études sur l’acupuncture s’est révélée peu concluante en raison des résultats hétérogènes. D’autres études sont nécessaires avant que l’on puisse faire des recommandations sur l’acupuncture ou la phytothérapie.