Clinical efficacy of pharmacological and non-pharmacological interventions for constipation-predominant irritable bowel syndrome

Abstract

BACKGROUND

Irritable bowel syndrome with constipation is the most common gastro-intestinal disorder that substantially affect bowel functionality, the burden of symptoms and the quality of life. Both pharmacological and non-pharmacological treatments are employed in clinical settings; however, there is limited comparative evidence regarding the effectiveness of these interventions.

AIM

To compare and rank the efficacy and safety of pharmacological and non-pharmacological interventions for constipation-predominant irritable bowel syndrome.

METHODS

A systematic review and Bayesian network meta-analysis of randomized controlled trials was conducted according to the preferred reporting items for systematic reviews and meta-analyses-network meta-analyses statement. PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, Wanfang, and VIP were searched from January 2007 to October 2025. Adults with constipation-predominant irritable bowel syndrome were included. Outcomes were complete spontaneous bowel movements, spontaneous bowel movements, Bristol stool form scale score, irritable bowel syndrome symptom severity scale score, irritable bowel syndrome quality of life score, and adverse events. Risk of bias was assessed using Cochrane RoB 2.0, and treatments were ranked by surface under the cumulative ranking curve.

RESULTS

Thirty-nine randomized controlled trials involving 15865 adults and 14 interventions were included. Acupuncture, tenapanor, and transcutaneous auricular vagus nerve stimulation ranked highest for complete spontaneous bowel movements. Tenapanor, transcutaneous auricular vagus nerve stimulation, and polyethylene glycol ranked highest for spontaneous bowel movements. Transcutaneous auricular vagus nerve stimulation, traditional Chinese medicine, and tenapanor ranked highest for Bristol stool form scale improvement. Acupuncture, probiotics, and transcutaneous auricular vagus nerve stimulation gave the best results for lowest ranked symptom severity denoting best benefit. The three therapies that reported the most benefit for quality of life were transcutaneous auricular vagus nerve stimulation, probiotics, and inulin. The risk of adverse events was lower in patients who received sensory adaptation training and transcutaneous auricular vagus nerve stimulation.

CONCLUSION

The benefits of pharmacological and non-pharmacological treatments for patients with constipation-predominant irritable bowel syndrome vary, but transcutaneous auricular vagus nerve stimulation, tenapanor, acupuncture, and probiotics appear particularly promising.

Keywords: Constipation-predominant irritable bowel syndrome; Pharmacological treatment; Non-pharmacological treatment; Clinical efficacy; Network meta-analysis; Systematic review

Core Tip: A comprehensive review and network meta-analysis has been conducted to determine the effectiveness of pharmacological and non-pharmacological therapies for constipation dominant irritable bowel syndrome. The assessment considered 14 different interventions depending on the important outcomes like frequency of bowel movements, consistency of stool, severity of symptoms, quality of life and adverse effects. According to the research, transcutaneous auricular vagus nerve stimulation, tenapanor, acupuncture, and probiotics are quite effective. These findings suggest the need for more personalized treatment approaches, and the need for further high-quality trials to confirm.