Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis

This comprehensive review examined the efficacy of acupuncture and related therapies for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal condition that significantly affects patients' quality of life. The researchers conducted a systematic analysis of 15 systematic reviews, including 27 randomized clinical trials with 2,141 participants, mainly from the Chinese population. The methodology involved a network meta-analysis to compare different acupuncture interventions with conventional pharmacological treatments. The acupuncture modalities evaluated included manual acupuncture with needles, electroacupuncture, moxibustion, auricular acupuncture, and catgut implantation techniques.

Pharmacological controls included antispasmodics such as pinaverium bromide and trimebutine, in addition to loperamide. Results demonstrated that several forms of acupuncture were superior to conventional medications in improving global IBS symptoms. Manual acupuncture showed significant benefits compared with pinaverium bromide (RR=1.16, 95% CI: 1.07-1.27), as did electroacupuncture (RR=1.21, 95% CI: 1.08-1.35). The combination of acupuncture with moxibustion also outperformed loperamide (RR=1.29, 95% CI: 1.09-1.52).

In the network meta-analysis, the combination of acupuncture with the Chinese herbal formula Geshanxiaoyao showed the highest probability of being the most effective treatment. Regarding safety, no serious adverse events related to acupuncture were reported. Side effects were minimal and transient, including mild hematomas at the application site. This contrasts with the adverse effects of conventional medications, such as dry mouth and blurred vision from antispasmodics, and dizziness and vomiting from loperamide.

Clinical implications suggest that acupuncture may be considered a valid alternative for patients who do not respond well to first-line conventional therapies or who have intolerance to medication adverse effects. The multimodal approach combining acupuncture with Chinese herbal medicine reflects traditional practice and showed promising results. However, several important limitations must be considered. All studies were conducted in China with Chinese populations, limiting the generalizability of the results.

The methodological quality of the systematic reviews was considered mediocre, and most studies presented a high risk of bias due to the absence of adequate blinding. Treatment duration was relatively short (2-7 weeks), not providing information on long-term effects. In addition, no studies were found comparing acupuncture with antidepressants, which are second-line treatments recommended for IBS. The diagnostic criteria used were primarily Rome III, and the results may not be directly applicable to the more recent Rome IV criteria.

Future research should address these limitations through multicenter studies including diverse populations, with longer follow-up and more rigorous methodology. It is important to investigate acupuncture as adjuvant therapy to antidepressants and to further explore the combined effects with Chinese herbal medicine. This evidence contributes to the growing field of integrative medicine in the treatment of functional gastrointestinal conditions, offering hope for patients seeking alternatives to conventional treatments.