Complementary medicines and irritable bowel syndrome - what works and what doesn't
In the first of a new 10-part series, professor of complementary medicine Edzard Ernst and colleagues sift through the evidence to find out what works and what doesn’t. This week, irritable bowel syndrome (IBS)
In the first of a new 10-part series, professor of complementary medicine Edzard Ernst and colleagues sift through the evidence to find out what works and what doesn't. This week, irritable bowel syndrome (IBS)
IBS is a chronic non-inflammatory condition affecting the small and large bowel. It is a functional disorder with no apparent structural or biochemical abnormalities. The main symptoms are cramping, abdominal pain, altered bowel habit such as diarrhoea or constipation, and abdominal bloating. IBS affects approximately 15 to 20% of the population and is one of the most common conditions seen by gastroenterologists and GPs.
Clinical bottom line
Fibre supplementation: bulk-forming agents seem beneficial for global symptom relief and IBS-related constipation.
Likely to be beneficial
• Chinese herbs: seem to improve symptoms. Tong Xie Yao Fang may lead to symptom improvement.
• Hypnotherapy: seems to improve symptoms and quality of life.
• Peppermint (Mentha x piperita): seems to improve symptoms.
• Probiotic (Lactobacillus plantarum): seems to be helpful for global improvement of symptoms.
• Psyllium (Plantago ovata): may be helpful for global improvement of symptoms.
• Acupuncture: most trials are of poor quality.
• Biofeedback: as part of a multi-component treatment, no effects on overall symptom scores.
• Carmint (Melissa officinalis, Mentha spicata, and Coriandrum sativum): may improve abdominal pain but not enough data available.
• CBT: some positive effects but not enough data available.
• Florelax (yeast, vitamin B, nicotinamide, folic acid, herbal extracts of camomile, angelica, valerian, peppermint): symptom improvement but little data available.
• Iberogast (Iberis amara, Chelidonii herba, Cardui mariae fructus, Melissae folium, Carvi fructus, Liquiritiae radix, Angelicae radix, Matricariae flos, Menthae piperitae folium): may lead to symptom improvement including abdominal pain but little data available.
• Meditation: little data and independent replication required.
• Padma Lax: a Tibetan herbal formula may improve symptoms but little data available.
• Probiotics (Bifidobacterium infantis, Propionibacterium, Prescript-Assist, VSL3): some positive effects reported yet not enough data available.
• Yoga: may improve symptoms but few data available.
Unlikely to be beneficial
• Aloe vera (Aloe barbadensis): seems not effective but diarrhoea-predominant patients showed a trend towards benefit.
• Asafoetida: some benefits reported but not beyond placebo.
• CBT: not better than attention placebo.
• Probiotics (Lactobacillus reuteri, Medilac DS, Bacillus subtilis, Streptococcus faecium): no effects on symptoms and quality of life.
• Reflexology: seems not effective for improving abdominal pain, distension and constipation or diarrhoea.
Likely to be ineffective or harmful
• Appital: a herbal combination preparation, likely to be ineffective.
• Ayurveda: preparation containing Aegle marmelos correa and Bacopa monnieri, likely to be ineffective.
• Curcuma xanthorriza: likely to be ineffective for pain and distension.
• Fumaria officinalis: likely to be ineffective.
- Best evidence suggests fibre is beneficial for global symptom relief and constipation. A number of other options are likely to be beneficial but the evidence is not fully convincing. Many conventional options are also not fully convincing.
- Fibre supplements should be taken with adequate amounts of fluid. Allergic reactions should be considered. The risk-benefit balance for fibre is positive.
Professor Edzard Ernst is professor of complementary medicine at Peninsula Medical School, Universities of Exeter and Plymouth.
Dr Max Pittler is senior research fellow in complementary medicine.
Barbara Wider is research fellow in complementary medicine.
Kate Boddy is information officer in complementary medicine.Distended rectum (lower centre) due to IBS IBS