Acupuncture for irritable bowel syndrome

No medical therapy has been shown to alter the natural history of irritable bowel syndrome (IBS).  A number of therapies have been used to improve the symptoms.  More data has been published on whether acupuncture is an effective therapy (Am J Gastroenterol 2012; 107: 835-47)

A number of treatment approaches have shown that several medical treatments are more effective than placebo, including soluble fiber, some antispasmotics, peppermint oil, antidepressants, and agents that act on the 5-HT receptor.  In addition, cognitive-behavioral therapy and hypnotherapy seem to be more effective than placebo.  Dietary therapies (see blog links below) are helpful in some patients.  However, many patients have a poor response to all of these approaches.

To examine whether acupuncture may be effective for IBS, the authors of the current study reviewed 1421 citations and identified 17 eligible randomized controlled trials (RCTs) with >1800 patients.  Only trials that used accepted traditional Chinese medicine methods of acupuncture were included.

Key findings:

  • Among the five sham-controlled trials, there was no significant difference detected between true acupuncture and sham acupuncture in terms of effects on symptoms or quality of life.  The standardized mean difference in post-treatment between the groups was -0.11 (difference between two groups) –confidence limits -0.35 to 0.13 for symptom severity and -0.03 for quality of life –confidence limits -0.27 to 0.22.
  • A selected summary on this article in Gastroenterology (2012; 143: 1683-84) notes that the largest RCT in the U.S. found that sham acupuncture and true acupuncture were both superior to a control arm (Am J Gastroenterol 2009; 104: 1489-97).
  • When acupuncture was compared with medical therapies in 5 trials (4 with antispasmodic, 1 with sulfasalazine), acupuncture was more effective, RR=1.28 for symptom improvement.  These studies were non blinded and the overall effect was modest.
  • When acupuncture was added to traditional Chinese medicine in 4 RCTs, the addition of acupuncture improved the endpoints of IBS symptom severity (RR=1.17).

This study should reduce the stress of practitioners of acupuncture.  Whether they apply true acupuncture or sham acupuncture, the results may be equivalent.  In these studies, sham acupuncture did have a high “placebo effect.” At the same time, this study indicates that the comparison medical treatments (most in these RCTs are not used in Western medicine) were less effective than acupuncture.  So where does that leave us?

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