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Intervention Review

Acupuncture for treatment of irritable bowel syndrome

  1. Byungmook Lim2,
  2. Eric Manheimer1,*,
  3. Lixing Lao3,
  4. Eric Ziea4,
  5. Julia Wisniewski5,
  6. Jianping Liu6,
  7. Brian M Berman3

Editorial Group: Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 16 AUG 2006

DOI: 10.1002/14651858.CD005111.pub2


How to Cite

Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman BM. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005111. DOI: 10.1002/14651858.CD005111.pub2.

Author Information

  1. 1

    University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, USA

  2. 2

    Korea Institute of Oriental Medicine, R&D Policy Team, Daejeon 305-811, Korea, South

  3. 3

    University of Maryland School of Medicine, Complementary Medicine Program, Baltimore, Maryland, USA

  4. 4

    Chinese University of Hong Kong, Department of Medicine and Therapeutics, 9/f, Hong Kong SAR, China

  5. 5

    The Mount Sinai Medical Center, New York, New York, USA

  6. 6

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine , Beijing, China

*Eric Manheimer, Center for Integrative Medicine, University of Maryland School of Medicine, Kernan Hospital Mansion, 2200 Kernan Drive, Baltimore, Maryland, 21207-6697, USA. emanheimer@compmed.umm.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Irritable bowel syndrome (IBS), a disorder of altered bowel habits associated with abdominal pain or discomfort. The pain, discomfort, and impairment from IBS often lead to healthcare medical consultation (Talley 1997) and workplace absenteeism, and associated economic costs (Leong 2003). A recent randomized controlled trial shows variable results but no clear evidence in support of acupuncture as an effective treatment for IBS (Fireman 2001).

Objectives

The objective of this systematic review is to determine whether acupuncture is more effective than no treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. Adverse events associated with acupuncture were also assessed.

Search methods

The following electronic bibliographic databases were searched irrespective of language, date of publication, and publication status: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, EMBASE, the Chinese Biomedical Database, the Cumulative Index to Nursing and Allied Health (CINAHL), and the Allied and Complementary Medicine Database (AMED). References in relevant reviews and RCTs were screened by hand. The last date for searching for studies was 7 February 2006.

Selection criteria

Published reports of randomized controlled trials (RCTs) and quasi-randomised trials of acupuncture therapy for IBS.

Data collection and analysis

All eligible records identified were dually evaluated for eligibility and dually abstracted. Methodological quality was assessed using the Jadad scale and the Linde Internal Validity Scale.

Data from individual trials were combined for meta-analysis when the interventions were sufficiently similar. Heterogeneity was assessed using the I squared statistic.

Main results

Six trials were included. The proportion of responders, as assessed by either the global symptom score or the patient-determined treatment success rate, did not show a significant difference between the acupuncture and the sham acupuncture group with a pooled relative risk of 1.28 (95% CI 0.83 to 1.98;n=109). Acupuncture treatment was also not significantly more effective than sham acupuncture for overall general well-being, individual symptoms (e.g., abdominal pain, defecation difficulties, diarrhea, and bloating), the number of improved patients assessed by blinded clinician, or the EuroQol score. For two of the studies without a sham control, acupuncture was more effective than control treatment for the improvement of symptoms: acupuncture versus herbal medication with a RR of 1.14(95% CI 1.00 to 1.31;n=132); acupuncture plus psychotherapy versus psychotherapy alone with a RR of 1.20 (95% CI 1.03 to 1.39;n=100). When the effect of ear acupuncture treatment was compared to an unclearly specified combination of one or more of the drugs diazepam, perphenazine or domperidone, the difference was not statistically significant with a RR of 1.49(95% CI 0.94 to 2.34;n=48).

Authors' conclusions

Most of the trials included in this review were of poor quality and were heterogeneous in terms of interventions, controls, and outcomes measured. With the exception of one outcome in common between two trials, data were not combined. Therefore, it is still inconclusive whether acupuncture is more effective than sham acupuncture or other interventions for treating IBS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Acupuncture for treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a disorder of altered bowel habits associated with abdominal pain or discomfort. Therapies for irritable bowel syndrome are generally directed at gastrointestinal motor, gastrointestinal sensory, or central nervous system processing; however, the efficacy of such conventional therapies varies from study to study, and the possibility of placebo effects make short-term studies difficult to interpret. The lack of effective therapies for irritable bowel syndrome is accompanied by increased use of complementary and alternative therapies, such as acupuncture. Acupuncture is receiving increasing acceptance in Western medicine for treating certain gastrointestinal disorders. When randomized controlled trials of acupuncture for irritable bowel syndrome were evaluated, some trials showed no clear evidence in support of acupuncture as an effective treatment for IBS, although other poor quality trials showed beneficial effects of acupuncture. There is no evidence to support the use of acupuncture for the treatment of irritable bowel syndrome. Acupuncture for irritable bowel syndrome needs further investigation.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以針灸治療激躁性結腸症候群

激躁性結腸症候群(IBS)是種排便習慣改變合併腹痛或不適的疾病。因激躁性結腸症候群引發的疼痛、不適和損傷通常需要保健醫療諮詢(Talley,1997)且影響工作出勤率、以及相隨的經濟成本(Leong,2003)。近期一個隨機性對照試驗有不同的結果,但沒有明確的證據支持針灸可有效地治療激躁性結腸症候群(Fireman,2001)。

目標

本系統性回顧目的在確定針灸治療激躁性結腸症候群是否優於無任何治療與”假”針灸治療(安慰性治療),或與其他治療相當。同時評估與針灸有關的不良事件。

搜尋策略

不限制語言、發表日期、發表狀態搜尋下列電子書目資料庫:MEDLINE、The Cochrane Library 的Cochrane Central Register of Controlled Trials (CENTRAL)、EMBASE、Chinese Biomedical Database、Cumulative Index to Nursing and Allied Health (CINAHL)以及Allied and Complementary Medicine Database (AMED)。並以人工方式搜尋相關文獻回顧與隨機性對照試驗的參考文獻。最後一次搜尋日期為2006年2月7日。

選擇標準

與針灸治療激躁性結腸症候群有關已發表的隨機性對照試驗和類隨機性試驗。

資料收集與分析

所有採用的記錄都經過雙重評估確認可用性並進行雙重摘取資料。利用Jadad量表和Linde內部效度量表評估研究方法品質。當試驗治療方式有相當的相似度時,則將彙整個別試驗的數據以進行統合分析。異質性以利用I平方統計分析評量。

主要結論

共收納6試驗,反應者的比例或以整體症狀評分或以患者自覺治療成功率進行評估,治療結果上針灸與假針灸兩者沒有顯著差異,其彙整相對風險值為1.28(95%信賴區間 0.83至1.98,樣本數109)。經由不知患者組別的醫師評量症狀改善患者數或以EuroQol評分表評量,在整體健康狀態或個別症狀(如腹痛、便祕、腹瀉、腹脹),針灸仍沒比假針灸有更顯著的功效。在2個沒有”假”針灸對照組的試驗中,針灸比對照組更能達到症狀改善的效果:針灸相對於藥草治療相對風險為1.14(95%信賴區間 1.00至1.31,樣本數132);針灸搭配心理治療相對於單獨心理治療的相對風險為1.20(95%信賴區間 1.03至1.39,樣本數100)。當比較耳部針灸相對於不特定混合Diazepam、Perphenazine或Domperidone合併治療時,兩組沒有統計上顯著差異,相對風險值為1.49(95%信賴區間 0.94至2.34,樣本數 48)。

作者結論

大多數本回顧納入的試驗品質不佳,而且在治療方法、對照組和檢測結果的有差異。除了在2個試驗有一個共同結果外,其他數據沒有彙整。因此仍無法確定針灸對治療激躁性結腸症候群比假針灸或是其他治療是否更有效。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據支持針灸治療激躁性結腸症候群的效果。激躁性結腸症候群(IBS)是種排便習慣改變合併腹痛或不適的疾病。一般激躁性結腸症候群治療針對胃腸道蠕動、胃腸道感覺器和中樞神經系統傳導處理;然而者些傳統治療的功效在各個研究間都不同,並且可能存在的安慰劑效應使得短期性研究的結果不易解析。因為缺乏對激躁性結腸症候群有效治療方法,增加像針灸這些輔助治療和替代性治療的使用。在西方醫學,針灸已漸漸被接受在治療某些胃腸道疾病。雖然一些實驗設計品質不佳的試驗顯示針灸能治療激躁性結腸症候群,但以隨機性對照試驗評估針灸治療激躁性結腸症候群的效果時,一些試驗沒有提供明確的證據支持針灸能有效地治療激躁性結腸症候群。需須要進行更多的試驗來研究針灸治療激躁性結腸症候群的效果。