scholarly journals Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis

2019 ◽  
Vol 12 ◽  
pp. 175628481882043 ◽  
Author(s):  
Irene X. Y. Wu ◽  
Charlene H. L. Wong ◽  
Robin S. T. Ho ◽  
William K. W. Cheung ◽  
Alexander C. Ford ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Systematic Reviews ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Treatment Options ◽  
Risk Of Bias ◽  
Chinese Herbs ◽  
Overview Of Systematic Reviews ◽  
Irritable Bowel ◽  
Needle Acupuncture

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. Conclusion: The 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.

scholarly journals Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis

2020 ◽  
Vol 9 ◽  
pp. 100511
Author(s):  
Irene X.Y. Wu ◽  
Charlene H.L. Wong ◽  
Robin S.T. Ho ◽  
William K.W. Cheung ◽  
Alexander C. Ford ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Overview Of Systematic Reviews ◽  
Irritable Bowel

scholarly journals Clinical Effects and Safety of Tongxieyaofang on Diarrhea Predominant Irritable Bowel Syndrome: A Meta-Analysis of Randomized Trails

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Yuhong Zhou ◽  
Shutang Han ◽  
Yamin He
Keyword(s):  
Irritable Bowel Syndrome ◽  
Large Scale ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Effective Rate ◽  
Risk Of Bias ◽  
Clinical Effects ◽  
Randomized Controlled ◽  
Study Results ◽  
Irritable Bowel

Background. Tongxieyaofang (TXYF), a prescription originated from traditional Chinese medicine (TCM), has been widely used on treating Diarrhea Predominant Irritable Bowel Syndrome (IBS-D). The purpose of this meta-analysis was to investigate whether TXYF was effective and safe for IBS-D. Methods. We searched seven electronic databases including CENTRAL, MEDLINE, PubMed, CNKI, VIP, CBM, and Wanfang Data up to 26 July 2017. Randomized controlled trails (RCTs) were eligible, regardless of blinding. Risk of bias of included trials was evaluated according to the Cochrane Handbook. Results. The total number of participants analyzed in the meta-analysis was 3062, of which 1556 received TXYF, while 1506 received ordinary treatment. The primary outcome was clinical effective rate. Compared with conventional medication which included probiotics, pinaverium bromide, trimebutine, and Oryzanol, TXYF significantly improved the clinical effective rate (n=37, OR: 4.61; 95% CI: 3.67–5.78; P < 0.00001) and decreased the adverse events (n=10, OR: 0.26; 95% CI: 0.08–0.86; P = 0.03). There was not significant association with the score of abdominal pain, defecating frequency, fecal property, and total symptom. Conclusions. We suggested a moderate recommendation for TXYF on IBS-D, due to the fact that the risk of bias of the finally included trails was not high. Considering that all identified studies were not of high qualities and large samples, further rigorously designed and large scale RCTs were necessary to improve the applicability of our study results.

Peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure patients: overview of systematic reviews and network meta-analysis

2021 ◽  
pp. 175791392098525
Author(s):  
CCW Zhong ◽  
CHL Wong ◽  
WKW Cheung ◽  
E-K Yeoh ◽  
CT Hung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Disease Management ◽  
Systematic Reviews ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Complex Interventions ◽  
Emergency Department Visits ◽  
Day Hospital ◽  
Overview Of Systematic Reviews

Aims: An overview of systematic reviews (SRs) and network meta-analysis (NMA) was conducted to synthesize evidence of comparative effectiveness of different peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure (HF) patients. Methods: We searched five databases for SRs from their inception to August 2019 and conducted additional search for randomized controlled trials (RCTs) published between 2003 and 2020. We used random-effect pairwise meta-analysis with pooled risk ratios (RRs) and 95% confidence intervals (CIs) to quantify the effect of complex interventions, and NMA to evaluate comparative effectiveness among complex interventions. Primary outcome was 30-day all-cause hospital readmissions, while secondary outcomes were 30-day HF-related hospital readmissions, 30-day mortality, and 30-day emergency department visits. Results: From 20 SRs and additional RCT search, 21 eligible RCTs ( n = 5362) assessing eight different peri-discharge complex interventions were included. Pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and controls on all outcomes, except that peri-discharge complex interventions were significantly more effective than controls in reducing 30-day mortality (pooled RR = 0.68, 95% CI: 0.49–0.95, 5 RCTs). NMA indicated that for reducing 30-day all-cause hospital readmissions, supportive–educative intervention had the highest probability to be the best intervention, followed by disease management; while for reducing 30-day HF-related hospital readmissions, disease management is likely to be the best intervention. Conclusions: Our results suggest that disease management has the best potential to reduce 30-day all-cause and HF-related hospital readmissions. Benefits of the interventions may vary across health system contexts. Evidence-based complex interventions require local adaptation prior to implementation.

scholarly journals Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-16
Author(s):  
Jianbo Guo ◽  
Xiaoxiao Xing ◽  
Jiani Wu ◽  
Hui Zhang ◽  
Yongen Yun ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Risk Of Bias ◽  
Acupuncture Group ◽  
Total Efficiency ◽  
Functional Diarrhea ◽  
Trimebutine Maleate ◽  
Irritable Bowel

Objective. To evaluate the clinical effectiveness and safety of acupuncture therapy in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea (FD) in adults. Method. Five electronic databases—PubMed, EMBASE, CNKI, VIP, and Wanfang—were searched, respectively, until June 8, 2020. The literature of clinical randomized controlled trials of acupuncture for the treatment of IBS-D or FD in adults were collected. Meta-analysis was conducted by Using Stata 16.0 software, the quality of the included studies was assessed by the RevMan ROB summary and graph, and the results were graded by GRADE. Result. Thirty-one studies with 3234 patients were included. Most of the studies were evaluated as low risk of bias related to selection bias, attrition bias, and reporting bias. Nevertheless, seven studies showed the high risk of bias due to incomplete outcome data. GRADE’s assessments were either moderate certainty or low certainty. Compared with loperamide, acupuncture showed more effectiveness in weekly defecation ( SMD = − 0.29 , 95% CI [-0.49, -0.08]), but no significant improvement in the result of the Bristol stool form ( SMD = − 0.28 , 95% CI [-0.68, 0.12]). In terms of the drop-off rate, although the acupuncture group was higher than the bacillus licheniformis plus beanxit group ( RR = 2.57 , 95% CI [0.24, 27.65]), loperamide group ( RR = 1.11 , 95% CI [0.57, 2.15]), and trimebutine maleate group ( RR = 1.19 , 95% CI [0.31, 4.53]), respectively, it was lower than the dicetel group ( RR = 0.83 , 95% CI [0.56, 1.23]) and affected the overall trend ( RR = 0.93 , 95% CI [0.67, 1.29]). Besides, acupuncture produced more significant effect than dicetel related to the total symptom score ( SMD = − 1.17 , 95% CI [-1.42, -0.93]), IBS quality of life ( SMD = 2.37 , 95% CI [1.94, 2.80]), recurrence rate ( RR = 0.43 , 95% CI [0.28, 0.66]), and IBS Symptom Severity Scale ( SMD = − 0.75 , 95% CI [-1.04, -0.47]). Compared to dicetel ( RR = 1.25 , 95% CI [1.18, 1.32]) and trimebutine maleate ( RR = 1.35 , 95% CI [1.13, 1.61]), acupuncture also showed more effective at total efficiency. The more adverse effect occurred in the acupuncture group when comparing with the dicetel group ( RR = 11.86 , 95% CI [1.58, 89.07]) and loperamide group ( RR = 4.42 , 95% CI [0.57, 33.97]), but most of the adverse reactions were mild hypodermic hemorrhage. Conclusion. Acupuncture treatment can improve the clinical effectiveness of IBS-D or FD, with great safety, but the above conclusions need to be further verified through the higher quality of evidence.

scholarly journals A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinsheng Wang ◽  
Pengcheng Yang ◽  
Lei Zhang ◽  
Xiaohua Hou
Keyword(s):  
Systematic Review ◽  
Irritable Bowel Syndrome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Stool Frequency ◽  
Stool Consistency ◽  
Controlled Trials ◽  
Irritable Bowel ◽  
Fodmap Diet

Background: A low-fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet has been reported to be associated with improving the symptoms of irritable bowel syndrome (IBS); however, its efficacy as evaluated by different studies remains controversial.Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to explore the efficacy of a low-FODMAP diet (LFD) in alleviating the symptoms of IBS.Methods: A search of the literature for RCTs that assessed the efficacy of an LFD in treating IBS patients was conducted using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. The searches in each database were conducted from the inception of the database to February 2021. Two independent reviewers screened citations and a third reviewer resolved disagreements. Two independent reviewers also performed eligibility assessments and data extraction. The RCTs that evaluated LFDs vs. a normal IBS or usual diet and assessed changes of IBS symptoms were included in the search. Data were synthesized as the relative risk of global symptoms improvement, mean difference of IBS Severity Scoring System (IBS-SSS) score, sub-items of IBS-SSS irritable bowel syndrome-related quality of life (IBS-QOL), hospital anxiety and depression scale (HADS), stool consistency/frequency, and body mass index (BMI) using a random effects model. The risk of bias was assessed using Risk of Bias Tool 2 (RoB 2). The bias of publication was assessed based on Egger's regression analysis. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results: A total of 2,768 citations were identified. After full-text screening, a total of 10 studies were eligible for the systematic review and were subsequently used to compare an LFD with various control interventions in 511 participants. An LFD was associated with the improvement of global symptoms [n = 420; Risk Ratio (RR) = 1.54; 95% Confidence Interval (CI) 1.18 to 2; I2 = 38%], improvement of stool consistency [n = 434; Mean difference (MD) = −0.25; 95% CI −0.44 to −0.06; I2= 19%), and a reduction trend of stool frequency (n = 434; MD = −0.28; 95% CI −0.57 to 0.01; I2 = 68%) compared with control interventions. There was no statistically significant change in IBS-QOL (n = 484; MD = 2.77; 95% CI −2 to 7.55; I2 = 62%), anxiety score (n = 150; MD = −0.45; 95% CI −3.38 to 2.49; I2 = 86%), depression score (n = 150; MD = −0.05; 95% CI −2.5 to 2.4; I2 = 88%), and BMI (n = 110; MD = −0.22; 95% CI −1.89 to 1.45; I2 = 14%). The overall quality of the data was “moderate” for “global improvement of IBS symptom,” “stool consistency,” “stool consistency for IBS with diarrhea (IBS-D),” and “stool frequency for IBS-D,” and “low” or “very low” for other outcomes according to GRADE criteria.Conclusion: An LFD is effective in reducing the global symptoms and improving the bowel habits of adult IBS patients. The efficacy for IBS-D patients can also be more pronounced.Systematic Review Registration: CRD42021235843.

scholarly journals Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110375
Author(s):  
Opeyemi O. Babatunde ◽  
Joie Ensor ◽  
Chris Littlewood ◽  
Linda Chesterton ◽  
Joanne L. Jordan ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Manual Therapy ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Treatment Options ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Short Term ◽  
And Function

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others.

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