Background Although existing clinical evidence has suggested potential effectiveness of acupuncture and related therapies for improving irritable bowel syndrome (IBS) symptoms, comparative effectiveness of different acupuncture modalities is unclear. An overview of systematic reviews (SRs) and a network meta-analysis (NMA) were conducted to evaluate the comparative effectiveness of acupuncture and related therapies used either alone, or as an add-on to other IBS treatments.
Methods Eight international and Chinese databases were searched for SRs of randomised controlled trials (RCTs) that investigated the effectiveness of acupuncture and related therapies among IBS patients. Data from eligible RCTs were extracted for random effect pairwise meta-analyses. NMA was used to evaluate the comparative effectiveness of different treatment options.
Results From 15 SRs, 28 RCTs (n=2314) assessing acupuncture and related therapies used either alone or as an add-on to other IBS treatments were included. Results from pairwise-meta-analysis showed that needle acupuncture was superior in improving global IBS symptoms, compared with both pinaverium bromide and trimebutine maleate. Electroacupuncture was found to have significantly stronger effects in alleviating global IBS symptoms when compared with pinaverium bromide. Needle acupuncture plus moxibustion was significantly more effective than loperamide in improving global IBS symptoms. Significant add-on effect was also observed in the pooled results of needle acupuncture plus Chinese herbal medicine (Geshanxiaoyao formula) when compared with Geshanxiaoyao formula alone. Results from NMA showed a combination of needle acupuncture and Geshanxiaoyao formula had the highest probability of being the best option for improving global IBS symptoms among 14 included treatment options. No serious adverse events associated with acupuncture and related therapies were reported.
Conclusions Amongst reviewed treatment options, the combination of needle acupuncture and Geshanxiaoyao formula had the highest probability of being the most effective treatment for global IBS symptoms. Patients who are contraindicated for current conventional pharmacological or non-pharmacological therapies may use acupuncture and related therapies. Future SRs should investigate the potential combination effect of other Chinese herbal medicine plus acupuncture and related therapies for treating IBS.
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