Some alternative therapies may be beneficial in IBS
Some complimentary alternative therapies, including herbal and dietary supplements, may help ease abdominal pain and benefit overall response in patients with irritable bowel syndrome, according to study results.
Andrea Shin, MD, of the Indiana University School of Medicine, and colleagues wrote that patients with IBS often seek complimentary alternative therapies (CAMs), whether they are satisfied with conventional medication or not, and their physicians should be prepared to advise them.
“It is important for physicians to understand the evidence behind CAM in order to appropriately counsel patients on their use,” they wrote. “To clarify the clinical utility of CAM for management of IBS, critical assessment of the available evidence that exists on this topic is required.”
Investigators searched the literature for randomized controlled trials that studied CAMs, including herbal therapy, dietary supplements, mind-body based, body based and energy healing, in patients with IBS compared with placebo or sham therapy. They analyzed the data to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk of overall response.
Researchers included data from 66 studies in their analysis.
Shin and colleagues found that herbal therapy demonstrated a benefit over placebo for abdominal pain (SMD = 0.47; 95% CI, 0.2–0.75). However, their confidence in the estimates was low. Mind-body based therapy also showed a borderline benefit over placebo (SMD = 0.29; 95% CI, -0.01 to 0.59).
Researchers also found that herbal therapy (RR = 1.57; 95% CI, 1.31-1.88), dietary supplements (RR = 1.95; 95% CI, 1.02-3.73) and mind-body based therapy (RR = 1.67; 95% CI, 1.13-2.49) showed a benefit for overall response compared with placebo.
“It would be beneficial for future studies to adopt the FDA’s guidance on pharmaceutical treatments for IBS,” Shin and colleagues wrote. “Further work on CAM in IBS should be pursued to maximize therapeutic options, increase CAM awareness among clinicians, and respond to patients’ needs and experiences in IBS.”
Perspective
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IBS is defined by symptoms of abdominal pain often associated with defecation and accompanied by a change in either the consistency of stool or bowel movement frequency. It is often subclassified into predominantly diarrhea (IBS-D), constipation (IBS-C), or mixed (IBS-M) categories. The etiopathogenesis of IBS is complex and incompletely understood, though believed to encompass an interplay between visceral hypersensitivity, gastrointestinal motility, alteration in gut microbiome, food irritants, inflammation and ultimately dysregulation between the gut-brain axis.
While several medications have been approved to treat IBS, all medical professionals should be aware of complementary and alternative approaches to treating this condition as patients will understandably seek non-pharmacologic approaches to ameliorate symptoms. In this impressive review of complementary and alternative therapy by Billings and colleagues, they focused on assessing whether dietary supplements, herbal therapy, mind-body based, body-based and energy-healing strategies improved abdominal pain and were overall efficacious. They specifically focused on studies where a placebo control was used to account for the large effect that placebo-based treatments can have in this domain. Overall, mind-body based therapy, such as cognitive behavioral therapy, and herbal based therapies improved abdominal pain. Diet, in addition to the aforementioned strategies, had an overall favorable response. The one caveat that the authors illustrate is that there was significant clinical heterogeneity amongst the trials when the trial data were compiled, making interpretation challenging. As such, additional rigorous trials will need to be conducted before robust conclusions can be formed. Regardless, patients and providers alike will continue to use complementary and alternative medicine to treat IBS. It is imperative that clinicians remain well versed on these interventions and the data that support their efficacy.
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