Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6488
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
Although nonpharmacological interventions (NPI) for irritable bowel syndrome (IBS) have been applied clinically, their relative efficacy and safety are poor understood.
The key significance of this network analysis is to compare and rank different NPIs in the treatment of IBS in clinical practice.
The aim of this study was to determine the rates of overall clinical efficacy and adverse effects, the scores of IBS symptom severity scale (IBS-SSS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS).
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.
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-SSS, SAS and SDS.
This study confirmed the efficacy and safety of NPIs for improving IBS symptoms, which to some extent recommended several interventions for clinical practice.
Future large RCTs should be performed to confirm the impact of NPIs on other IBS symptoms, and additional high-quality clinical researches should be conducted to offer more powerful evidence in the future.