The effect of acupuncture on quality of life in patients with irritable bowel syndrome: A systematic review and meta-analysis

This meta-analysis represents the most comprehensive assessment to date of the effects of acupuncture on quality of life in patients with irritable bowel syndrome (IBS), analyzing data from 14 randomized controlled trials involving 2,038 participants across multiple countries, including China, the United Kingdom, Germany, the United States, Turkey, and Canada. IBS is a functional bowel disorder affecting 3-15% of the world's population, characterized by recurrent abdominal pain and altered bowel habits, with substantial impact on quality of life and considerable economic costs. The investigators conducted a systematic search of four major databases (PubMed, Cochrane, Embase, and Web of Science) through September 2023, including only randomized controlled trials published in English that compared acupuncture (manual, electroacupuncture, or transcutaneous stimulation) with appropriate controls (sham acupuncture, medications, or usual care). The primary outcome was quality of life measured by validated scales, primarily IBS-QOL, while secondary outcomes included the symptom severity scale (IBS-SSS) and abdominal pain.

The analysis showed that acupuncture provided significant improvement in quality of life compared with conventional treatment (mean difference = 6.62 points; 95% CI: 2.30 to 10.94; p<0.001), a clinically relevant result that remained consistent even with moderate heterogeneity across studies (I²=72.45%). Additionally, acupuncture demonstrated superiority in reducing IBS symptom severity (mean difference = -46.58 points; 95% CI: -91.49 to -1.68; p<0.001), indicating substantial symptomatic benefits. Subgroup analyses provided valuable insights into optimal treatment parameters, suggesting that 30-minute sessions, performed up to five times per week for four weeks, represent the most effective protocol for improving quality of life. Interestingly, acupuncture proved superior to conventional medications for improving quality of life, offering an important therapeutic alternative considering that many IBS medications produce adverse effects such as nausea and constipation.

Detailed analysis of the eight IBS-QOL dimensions revealed that acupuncture was particularly effective in improving somatic complaints, health concerns, interpersonal relationships, sexual problems, and interference with daily activities, demonstrating holistic benefits beyond symptomatic relief. Regarding safety, only three studies reported adverse events, all transient and mild, including subcutaneous hematoma, abdominal pain, cold extremities, and neural pain, with no serious adverse effects. However, acupuncture did not demonstrate significant efficacy for reducing abdominal pain compared with controls, a result that differs from some prior meta-analyses and may relate to differences in treatment protocols or inadequate sample size for this specific outcome. Limitations of the study include a predominant focus on short-term efficacy, relatively small sample sizes in most individual studies, geographic concentration of studies (mainly China), reliance on subjective outcome measures, and lack of long-term follow-up data.

Despite these limitations, overall methodological quality was considered good, with low risk of bias in most assessed domains. Proposed mechanisms for the benefits of acupuncture include modulation of intestinal inflammation through inhibition of TRPV1 channels in peripheral sensory neurons, regulation of serotonin receptors (reduction of 5-HT3R and increase of 5-HT4R), improved gastrointestinal motility, and central effects on the hypothalamic-pituitary-adrenal axis, resulting in reduced visceral hypersensitivity characteristic of IBS. These findings have important clinical implications, especially considering the increased incidence of IBS during the COVID-19 pandemic and the growing demand for integrative therapies. Acupuncture emerges as a safe and effective therapeutic option that can be integrated into conventional IBS management, offering particular benefits for patients who do not tolerate or respond adequately to conventional medications.