Chinese Herbal Medicine for Irritable Bowel Syndrome: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Purpose: Chinese herbal medicine (CHM) is an important complementary and alternative therapy for the management of irritable bowel syndrome (IBS). Previous meta-analyses suggested that CHM is effective for IBS; nonetheless, its effectiveness is inconclusive owing to repeated significance testing. We aimed to examine the efficacy and safety of CHM for IBS through a meta-analysis and trial sequential analysis (TSA).Methods: We searched OVID Medline, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from January 1, 1980, to September 20, 2020. The primary outcome was adequate relief of global IBS symptoms. The secondary outcomes included relief of abdominal pain and treatment-related adverse events. The relative ratio (RR) and required information size (RIS) were calculated for each outcome.Results: Ten trials recruiting 2,501 participants were included. Seven (70%) trials were at low risk of bias (RoB). Compared with placebo, CHM was associated with a significantly higher proportion of adequate relief of global IBS symptoms [RR 1.76 (95% confidence interval (95%CI), 1.33–2.33); I2 = 81.1%; p < 0.001]. The RIS was 1,083 for the primary outcome, and the accrued information size was 1,716. The analysis of the relief of abdominal pain (three trials with 916 participants) showed similar results compared with placebo [RR 1.85 (95%CI, 1.59–2.14); I2 = 0%; p < 0.001; RIS = 197 participants]. CHM was associated with a higher proportion of adverse events compared with placebo [RR 1.51 (95%CI, 1.14–2); I2 = 0%; p = 0.004].Conclusion: CHM was effective in relieving IBS symptoms but caused a higher adverse event rate than placebo. TSA analysis confirmed the findings with sufficient information size.

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Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/7680963 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16 ◽

Cited By ~ 1

Author(s):

Jing Yan ◽

Zhi-wei Miao ◽

Jun Lu ◽

Fei Ge ◽

Li-hua Yu ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Western Medicine ◽

Meta Analysis ◽

Controlled Trials ◽

Combined Method ◽

Chinese Herbal ◽

Irritable Bowel

Purpose. To 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. Results. A 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. Conclusions. Findings 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.

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Pharmacological treatments of Chinese herbal medicine for irritable bowel syndrome in adults: A network meta-analysis of randomized controlled trials

PLoS ONE ◽

10.1371/journal.pone.0255665 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255665

Author(s):

Yun-bo Wu ◽

Yun-kai Dai ◽

Ling Zhang ◽

Huai-geng Pan ◽

Wei-jing Chen ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Herbal Medicine ◽

Randomized Controlled Trials ◽

Chinese Herbal Medicine ◽

Clinical Symptoms ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Chinese Herbal ◽

Irritable Bowel

Introduction Plenty of clinical studies have suggested the value of Chinese herbal medicine (CHM) for patients with irritable bowel syndrome (IBS), but their efficacy and safety have not been systematically concluded yet. This article aimed to compare and rank the therapeutic effect and safety of CHM with routine pharmacotherapies and placebo in the treatment of IBS. Methods Randomized controlled trials regarding CHM to treat IBS were searched in six databases from inception to Jan 31, 2020. A network meta-analysis was conducted to analyze the data of included publications. The quality assessment was assessed by Cochrane Handbook and GRADEpro software. The risk ratio was calculated for dichotomous outcomes while the standardized mean difference was used for continuous variables with 95% credible intervals. A Funnel plot was performed to evaluate publication bias. The surface under the cumulative ranking curve was conducted to rank the included interventions. Data were analyzed with STATA 15.0 and Review Manager 5.3. Result 3194 records were searched, and 28 eligible trials involving 3323 patients ere identified. Compared with conventional therapies and placebo, Jianpi-Chushi therapy showed significant improvement in adequate relief and IBS symptom severity scale; Shugan-Jianpi therapy showed the best efficacy in relieving the abdominal pain and abdominal distension; Wenshen-Jianpi therapy had a better effect on avoiding adverse effects and improving stool character. Conclusion This study confirmed that CHM could be beneficial for patients with IBS in relieving their clinical symptoms and should be recommended as alternative therapies. The quality of evidence in this study based on the GRADE system was “low”.

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Adding Chinese herbal medicine to probiotics for irritable bowel syndrome-diarrhea: A systematic review and meta-analysis of randomized controlled trials

Journal of Traditional Chinese Medical Sciences ◽

10.1016/j.jtcms.2020.01.004 ◽

2020 ◽

Vol 7 (1) ◽

pp. 20-36 ◽

Cited By ~ 1

Author(s):

Fanlong Bu ◽

Weiguang Wang ◽

Ruilin Chen ◽

Ziyi Lin ◽

Mei Han ◽

...

Keyword(s):

Systematic Review ◽

Irritable Bowel Syndrome ◽

Herbal Medicine ◽

Randomized Controlled Trials ◽

Chinese Herbal Medicine ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Chinese Herbal ◽

Irritable Bowel

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Efficacy of Chinese Herbal Medicine for Diarrhea-Predominant Irritable Bowel Syndrome: A Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/4071260 ◽

2016 ◽

Vol 2016 ◽

pp. 1-15 ◽

Cited By ~ 10

Author(s):

Jia-Jie Zhu ◽

Shan Liu ◽

Xiao-Lan Su ◽

Zi-Song Wang ◽

Yu Guo ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Meta Analysis ◽

Small Sample ◽

Controlled Trials ◽

Double Blind ◽

Chinese Herbal ◽

Threshold Assessment ◽

Irritable Bowel

Objective. To explore the efficacy of Chinese herbal medicine in treating diarrhea-predominant irritable bowel syndrome (D-IBS).Methods. Four English and four Chinese databases were searched through November, 2015. Randomized, double-blind and placebo-controlled trials were selected. Data extraction and quality evaluation were performed by two authors independently. RevMan 5.2.0 software was applied to analyze the data of included trials.Results. A total of 14 trials involving 1551 patients were included. Meta-analysis demonstrated superior global symptom improvement (RR = 1.62; 95% CI 1.31, 2.00;P<0.00001; number needed to treat = 3.6), abdominal pain improvement (RR = 1.95; 95% CI 1.61, 2.35;P<0.00001), diarrhea improvement (RR = 1.87; 95% CI 1.60, 2.20;P<0.00001), pain threshold assessment (MD = 54.53; 95% CI 38.76, 70.30;P<0.00001), and lower IBS Symptom Severity Score (SMD = −1.01; 95% CI −1.72, −0.30;P=0.005), when compared with placebo, while for defecation threshold assessment, quality of life, and adverse events, no differences were found between treatment groups and controlled groups.Conclusion. This meta-analysis shows that Chinese herbal medicine is an effective and safe treatment for D-IBS. However, due to the small sample size and high heterogeneity, further studies are required.

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