Treatment of Irritable Bowel Syndrome by Chinese Medicine: A Review

Irritable bowel syndrome: Epidemiology, overlap disorders, pathophysiology and treatment

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disease with a significant impact on patients' quality of life and a high socioeconomic burden. And the understanding of IBS has changed since the release of the Rome IV diagnosis in 2016. With the upcoming Rome V revision, it is necessary to review the results of IBS research in recent years. In this review of IBS, we can highlight future concerns by reviewing the results of IBS research on epidemiology, overlap disorders, pathophysiology, and treatment over the past decade and summarizing the latest research.

Acupuncture therapy for radiotherapy-induced adverse effect: A systematic review and network meta-analysis

Objective

To evaluate the efficacy of different acupuncture therapies for radiotherapy-induced adverse effects (RIAEs) and find out the optimal scheme.

Methods

Eligible randomized controlled trials (RCTs) were collected from inception to June 2020 from 9 bibliographic databases. The risk of bias evaluation of the analyzed literature was carried out using the Cochrane risk-of-bias tool. Network meta-analysis was mainly performed using STATA 14.2 and OpenBUGS 3.2.3 by figuring out the network diagrams, league figures, and SUCRA values.

Results

A total of 41 studies with 3,011 participants reported data suitable for network meta-analysis. There was a low to moderate risk of bias in twenty of the articles. ST36 was the most widely prescribed acupoint. Based on network meta-analysis, four outcome indicators were described, namely, acupuncture + medication ranked first in treating radiation enteritis, moxibustion + medication ranked first in preventing radiotherapy-induced leukopenia, acupuncture + medication ranked first in preventing radioactive oral mucositis, and acupuncture ranked first in improving the stimulated salivary flow rate of radioactive xerostomia.

Conclusion

The findings of the network meta-analysis manifested that acupuncture therapy combined with medication has superiority in most RIAEs, both reducing incidence and relieving symptoms. However, high-quality studies are still needed to provide conclusive evidence.

Systematic review registration

https://inplasy.com/inplasy-2020-7-0054/, identifier: INPLASY202070054.

Chaihu-Guizhi-Ganjiang Decoction is more efficacious in treating irritable bowel syndrome than Dicetel according to metabolomics analysis

Background

Chaihu-Guizhi-Ganjiang Decoction (CGGD) is a traditional Chinese medicine (TCM) prescription used to treat viral influenza. There is evidence that CGGD can be used to treat irritable bowel syndrome (IBS) but the potential mechanism of action and metabolites produced upon CGGD treatment remains elusive.

Methods

Patients with IBS were treated with pinaverium bromide (Dicetel™) and then CGGD after a washout period of 1 week. Both treatments lasted for 30 days. The efficacy and changes of metabolites in plasma after the two treatments were compared. Plasma samples were acquired before and after each treatment, and untargeted metabolics analysis was performed.

Results

Efficacy was measured according to the Rome IV criteria and TCM theory. Our results indicated that CGGD showed significantly better efficacy than Dicetel in the treatment of IBS utilizing each criterion. CGGD exerted greater effects on plasma metabolism than Dicetel. Dicetel treatment led to increased tryptophan metabolism (increased levels of 5-Hydroxyindoleacetaldehyde) and increased protein metabolism (increased levels of L-arginine). CGGD treatment significantly (p < 0.05) increased carnitine metabolism, with elevated levels of L-carnitine and acylcarnitine in plasma. Such changes in these metabolites could exert effects against IBS by improving gastrointestinal motility and suppressing pain, depression, and inflammation.

Conclusions

CGGD appeared to be more efficacious than Dicetel for treating patients with IBS. The findings provide a sound support for the underlying biomolecular mechanism of CGGD in the prevention and treatment of IBS.

An Overview of Systematic Reviews of Herbal Medicine for Irritable Bowel Syndrome

Background: Irritable bowel syndrome (IBS) is a common disorder with abdominal pain and bowel habits changes. Herbal medicines (HMs) are frequently used in the treatment of IBS. Therefore, several systematic reviews (SRs) have been conducted to assess the efficacy and safety of HM in IBS patients. This study aimed to investigate the methodology and quality of evidence of SRs, and to describe the current state of research and evidence for the treatment of IBS with HM.

Methods: SRs published up to January 2022 were searched using six electronic databases. SRs and/or meta-analyses on the use of HMs for IBS were included. The effects of placebo, conventional medicine (CM), and probiotics were compared with those of HMs. Two investigators independently extracted the data and assessed methodological quality using the Measure Tool to Assessment System Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of evidence for each main finding.

Results: Eighteen SRs were included in this overview. Among them, eight SRs reported only specific subtypes of IBS: six SRs reported patients with diarrhea-predominant IBS, and two SRs reported patients with constipation-predominant IBS. In terms of total efficacy, HM was more effective than placebo, CM, or probiotics. HM showed a more significant effect than CM in relieving independent IBS symptom score (abdominal pain score, diarrhea score, abdominal distension score, stool frequency score, etc.) and recurrence rate. The rate of adverse events was significantly lower with HM compared to CM, and no serious adverse events were reported with HM treatment. According to AMSTAR 2, the methodological quality of the included SRs was extremely low. Furthermore, the quality of evidence for total efficacy was considered low or very low according to the GRADE tool.

Conclusion: HM can be considered as an effective and safe treatment for IBS. However, the methodological quality of the included SRs and the quality of evidence was generally low. Therefore, well-designed randomized controlled trials are needed in the future so that a high-quality SR can be used to better assess the safety and efficacy of HM in the treatment of IBS.

Systematic Review Registration:https://osf.io/nt6wz, identifier 10.17605/OSF.IO/NT6WZ.