Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2020; 26(41): 6488-6509
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6488
Efficacy and safety of non-pharmacological interventions for irritable bowel syndrome in adults
Yun-Kai Dai, Yun-Bo Wu, Ru-Liu Li, Wei-Jing Chen, Chun-Zhi Tang, Li-Ming Lu, Ling Hu
Yun-Kai Dai, Yun-Bo Wu, Ru-Liu Li, Wei-Jing Chen, Ling Hu, Institute of Gastroenterology, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
Chun-Zhi Tang, Li-Ming Lu, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Author contributions: Hu L and Lu LM conceived and designed the study; Dai YK and Wu YB performed the experiment and analyzed the data; Dai YK wrote the paper; Li RL, Chen WJ, Tang CZ, Lu LM and Hu L supervised the study; All authors approved the final manuscript as submitted.
Supported by National Natural Science Foundation of China, No. 81774238, No. 81373563, and No. 30772689; Construction of Chinese First-class Discipline of Guangzhou University of Chinese Medicine, 2017, No. 70; Construction of Chinese First-class Discipline Research of Key Project of Guangzhou University of Chinese Medicine ([2020] No. 62, [2019] No. 5, and [2018] No. 6); Construction of High-level University of Guangzhou University of Chinese Medicine (2016, No. 64); and Innovation Team to Foster Scientific Research Projects of Guangzhou University of Chinese Medicine, No. 2016KYTD07.
Conflict-of-interest statement: All authors disclosed no competing interests in any aspects.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ling Hu, PhD, Professor, Institute of Gastroenterology, Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, No. 12 Jichang Road, Baiyun District, Guangzhou 510405, Guangdong Province, China. drhuling@163.com
Received: July 10, 2020
Peer-review started: July 10, 2020
First decision: August 8, 2020
Revised: August 21, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 7, 2020
Abstract
BACKGROUND

Although nonpharmacological interventions (NPI) for irritable bowel syndrome (IBS) have been applied clinically, their relative efficacy and safety are poorly understood.

AIM

To compare and rank different NPI in the treatment of IBS.

METHODS

Five electronic databases were searched from their inception to January 12, 2020. Data of included publications were analyzed using network meta-analysis (NMA). Quality of endpoints were assessed by tools of the Cochrane Handbook and the GRADEpro software. Pooled relative risk or standardized mean difference with their corresponding 95% confidence intervals were used for statistical analysis. Surface under the cumulative ranking curve (SUCRA) probability value was conducted to rank the examined interventions. Sensitivity analysis was performed to verify the robustness of results and test the source of heterogeneity.

RESULTS

Forty randomized controlled trials with 4196 participants were included in this NMA. Compared with routine pharmacotherapies and placebo, acupuncture and cognitive behavioral therapy (CBT) had better efficacy in relieving IBS symptoms. Based on the SUCRA values, acupuncture ranked first in improving overall clinical efficacy and avoiding adverse effects. CBT ranked first in lowering the scores of IBS symptom severity scale, self-rating anxiety scale and self-rating depression scale.

CONCLUSION

This study confirmed the efficacy and safety of NPI for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.

Keywords: Nonpharmacological interventions, Irritable bowel syndrome, Network meta-analysis, Randomized controlled trials, Adults, Clinical practice

Core Tip: This is the first study to compare nonpharmacological interventions including biofeedback, cognitive behavioral therapy, probiotics, dietary, acupuncture, and moxibustion using network meta-analysis.