Different interventions for the treatment of irritable bowel syndrome-adjusted indirect comparison

Background Many therapies are commonly used to help treat irritable bowel syndrome (IBS), including pharmacological and non-pharmacological approaches. However, there is a lack of direct evidence to help the clinicians make a decision. Objectives The aim of this review is to determine whether one of the approaches is more benefit than any of the others for the treatment of IBS through adjusted indirect comparison. Methods We searched the Cochrane Library (from inception to March 2014) using the keyword “irritable bowel syndrome” for systematic reviews. According to the pre-specified selection criteria, qualified trials were selected from the identified reviews. We calculated pooled random- or fixed-effects estimates according to the type of treatment for the proportions of treatment response. Adjusted indirect comparison was used for the pooled RRs of any two types of treatments with placebo as the common control. The primary outcome was improvement of patients global assessment. The second outcome included the improvement of IBS-symptom score and improvement of symptoms of abdominal pain. Results Nine systematic reviews were identified including 203 trials. Ultimately, 62 studies (N= 11,326) fulfilled inclusion criteria. For primary outcome global assessment, herbal medicine was associated with greater effects than western active medicine (RR, 1.34 [95%CI, 1.03-1.75]). For secondary outcome, the adjusted indirect comparison showed that there was no statistically significant difference between acupuncture and western active medicine in symptom severity. Herbal medicine may possibly be more effective than western active medicine in reducing abdominal pain, although the wide confidence intervals preclude any definite conclusions, with a RR of 1.18 [95%CI, 0.65-2.15]. Conclusions Herbal medicine may be more effective than western active medicine for the treatment of irritable bowel syndrome, especially in relieving the global symptoms, which may help t- e clinicians to make a decision in routine practice.