Irritable Bowel Syndrome and Complementary Health Approaches: What the Science Says
Clinical Guidelines, Scientific Literature, Info for Patients:
Irritable Bowel Syndrome and Complementary Health Approaches
There is some evidence that suggests some probiotics may improve symptoms of IBS; however, benefits have not been conclusively demonstrated, and not all probiotics have the same effects.
What Does the Research Show?
- In a 2018 monograph, the American College of Gastroenterology concluded that probiotics, taken as a group, improve global symptoms of IBS, including bloating and flatulence. However, the recommendation was “weak,” and the quality of evidence was “low.”
- A 2018 systematic review and meta-analysis of 53 studies involving a total of 5,545 participants found that probiotics may have beneficial effects on global IBS symptoms and abdominal pain, but it was not possible to draw definitive conclusions about their effectiveness or to identify which species, strains, or combinations of probiotics are mostly likely to produce benefits.
- A 2014 systematic review and meta-analysis of 43 randomized controlled trials found that probiotics had beneficial effects on global IBS symptoms, abdominal pain, bloating, and flatulence scores; however, the species and strains that provide the most beneficial effects are unclear.
- In healthy people, probiotics usually have only minor side effects, if any. However, in people with underlying health problems (for example, weakened immune systems), serious complications, such as infections, have occasionally been reported.
- Most research about safety of probiotics comes from studies of Lactobacillus and Bifidobacterium; less is known about other probiotic strains.
Some studies have suggested benefit of hypnotherapy for IBS symptoms, including gastrointestinal symptoms, anxiety, depression, disability, and health-related quality of life. Significant relief from pain-related functional gastrointestinal pain disorders in children has been reported after hypnotherapy compared with standard care or wait-list approaches; however, overall, the evidence is limited.
What Does the Research Show?
- A 2018 monograph from the American College of Gastroenterology concluded: “We suggest some psychological therapies (provider-directed cognitive behavioral therapy, relaxation therapy, hypnotherapy, and multicomponent psychological therapy) for overall symptom improvement in IBS patients,” assigning the recommendation as “weak” and the quality of evidence as “very low.”
- A 2015 systematic review of 24 randomized controlled trials involving a total of 1,390 children with pain-related functional gastrointestinal pain disorders found that significant improvement in abdominal pain was reported after hypnotherapy compared with standard care or wait-list approaches.
- A 2015 review of seven randomized trials of gut-directed hypnotherapy for IBS found that six of those trials reported a significant reduction in overall gastrointestinal symptoms compared to supportive therapy only. The reviewers concluded that gut-directed hypnotherapy has durable efficacy in patients with IBS, but there is not enough evidence to determine whether hypnotherapy belongs as a primary or adjunctive therapy option for patients with IBS.
- A 2017 randomized clinical trial involving 250 children with IBS compared the effectiveness of hypnotherapy by means of home-based self-exercises using a CD with that of individual hypnotherapy performed by qualified therapists. The study found that directly after treatment, 36.8 percent of children in the CD group and 50.1 percent of children in the individual hypnotherapy group had significant reduction (50 percent or greater) in pain frequency and intensity. After 1-year follow-up, both groups had comparable significant reductions in these symptoms.
- Gut-directed hypnosis is generally considered safe and tolerable among children and adults when led by licensed hypnotherapists with special training in this technique.
There is some evidence that enteric-coated peppermint oil capsules may be modestly efficacious, in the short-term, in reducing several common symptoms of IBS, in particular abdominal pain, bloating, and gas. Long-term efficacy has not been established.
What Does the Research Show?
- A 2018 monograph from the American College of Gastroenterology suggests peppermint oil for overall symptom management in IBS patients. However, based on the evidence, they assigned the recommendation as “weak” and the quality of evidence as “low.”
- A 2014 systematic review and meta-analysis of nine studies involving a total of 726 participants found peppermint oil to be superior to placebo for global improvement of IBS symptoms and improvement in abdominal pain.
- Non-enteric coated forms of peppermint oil may cause or worsen heartburn symptoms, but otherwise appears to be generally safe over the short-term.
The evidence that herbal remedies might improve IBS symptoms is very limited, and much of the data available is based on studies with inadequate methodology and small sample populations.
What Does the Research Show?
- A 2017 double-blind, randomized, placebo-controlled trial involving 99 participants found that those who received an herbal remedy (IQP-CL-101) containing a mixture of curcuminoids and essential oils from different Curcuma species, besides fish oil, peppermint oil, caraway oil and vitamins B1, B9, and D3 had a significant reduction in IBS symptoms compared to placebo.
- A 2011 Cochrane review of 75 randomized controlled trials involving a total of 7,957 participants with IBS concluded that while some herbal remedies may improve IBS symptoms, positive findings from less rigorous trials should be interpreted with caution due to inadequate methodology, small sample sizes, and lack of confirming data.
- Herbal supplements may contain dozens of compounds and all of its ingredients may not be known.
- Some herbs can interact with medications. For example, St. John’s wort is a potent inducer of both cytochrome P-450 enzymes and intestinal P-glycoprotein. Clinically significant interactions have been documented with St. John’s wort and cyclosporine, the antiretroviral agent indinavir, oral contraceptives, coumadin, digoxin, and benzodiazepines, among others.
- Some herbs can cause serious side effects. For example, comfrey and kava can cause liver toxicity.
In sham-controlled, randomized trials, acupuncture was found to be no better than placebo for IBS symptom severity or health-related quality of life. In Chinese studies, acupuncture appeared to provide greater benefits than two antispasmodic drugs, although these benefits may have been due to patient preferences or expectations of improvement.
What Does the Research Show?
- A 2014 meta-analysis of six randomized, placebo-controlled trials found some benefit of acupuncture for IBS symptoms; however, only one of the six studies showed a positive effect. The authors concluded that data are insufficient to establish long-term results or to recommend acupuncture as first-line treatment.
- A 2012 Cochrane review of 17 randomized controlled trials involving a total of 1,806 participants found no evidence of an improvement with acupuncture compared to a sham acupuncture control for symptom severity or quality of life. The review also included four Chinese comparative effectiveness trials and found acupuncture to provide greater benefits than two antispasmodic drugs (pinaverium bromide and trimebutine maleate), which have been known to provide modest benefits for IBS symptoms. However, it is unclear if the benefits of acupuncture in these studies were due to patient preferences or expectation of improvement.
- Relatively few complications from using acupuncture have been reported. Still, complications have resulted from use of non-sterile needles and improper delivery of treatments.
- When not delivered properly, acupuncture can cause serious adverse effects, including infections, bleeding, pneumothorax and injury to the central nervous system.
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- Chao GQ, Zhang S. Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2014;20(7):1870–1877.
- Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;;48(10):1044-1060.
- Ford AC, Moayyedi P, Chey WD, et al. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2018;113(Suppl 2):1-18.
- Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008;337:a2313.
- Ford AC, Quigley EM, Lacy BE, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1350–1365.
- Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547–1561.
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- Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3):325–332.
- Moser G, Trägner S, Gajowniczek EE, et al. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108(4):602–609.
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- Rutten JM, Korterink JJ, Venmans LM, et al. Nonpharmacologic treatment of functional abdominal pain disorders: a systematic review. Pediatrics. 2015;135(3):522–535.
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