Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis
Jianbo Guo, Xiaoxiao Xing, Jiani Wu, Hui Zhang, Yongen Yun, Zongshi Qin, Qingyong He
Abstract
Objective. To evaluate the clinical effectiveness and safety of acupuncture therapy in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) or functional diarrhea (FD) in adults. Method. Five electronic databases—PubMed, EMBASE, CNKI, VIP, and Wanfang—were searched, respectively, until June 8, 2020. The literature of clinical randomized controlled trials of acupuncture for the treatment of IBS-D or FD in adults were collected. Meta-analysis was conducted by Using Stata 16.0 software, the quality of the included studies was assessed by the RevMan ROB summary and graph, and the results were graded by GRADE. Result. Thirty-one studies with 3234 patients were included. Most of the studies were evaluated as low risk of bias related to selection bias, attrition bias, and reporting bias. Nevertheless, seven studies showed the high risk of bias due to incomplete outcome data. GRADE’s assessments were either moderate certainty or low certainty. Compared with loperamide, acupuncture showed more effectiveness in weekly defecation ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>SMD</a:mtext> <a:mo>=</a:mo> <a:mo>−</a:mo> <a:mn>0.29</a:mn> </a:math> , 95% CI [-0.49, -0.08]), but no significant improvement in the result of the Bristol stool form ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>SMD</c:mtext> <c:mo>=</c:mo> <c:mo>−</c:mo> <c:mn>0.28</c:mn> </c:math> , 95% CI [-0.68, 0.12]). In terms of the drop-off rate, although the acupuncture group was higher than the bacillus licheniformis plus beanxit group ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mtext>RR</e:mtext> <e:mo>=</e:mo> <e:mn>2.57</e:mn> </e:math> , 95% CI [0.24, 27.65]), loperamide group ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>RR</g:mtext> <g:mo>=</g:mo> <g:mn>1.11</g:mn> </g:math> , 95% CI [0.57, 2.15]), and trimebutine maleate group ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mtext>RR</i:mtext> <i:mo>=</i:mo> <i:mn>1.19</i:mn> </i:math> , 95% CI [0.31, 4.53]), respectively, it was lower than the dicetel group ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mtext>RR</k:mtext> <k:mo>=</k:mo> <k:mn>0.83</k:mn> </k:math> , 95% CI [0.56, 1.23]) and affected the overall trend ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mtext>RR</m:mtext> <m:mo>=</m:mo> <m:mn>0.93</m:mn> </m:math> , 95% CI [0.67, 1.29]). Besides, acupuncture produced more significant effect than dicetel related to the total symptom score ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mtext>SMD</o:mtext> <o:mo>=</o:mo> <o:mo>−</o:mo> <o:mn>1.17</o:mn> </o:math> , 95% CI [-1.42, -0.93]), IBS quality of life ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mtext>SMD</q:mtext> <q:mo>=</q:mo> <q:mn>2.37</q:mn> </q:math> , 95% CI [1.94, 2.80]), recurrence rate ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mtext>RR</s:mtext> <s:mo>=</s:mo> <s:mn>0.43</s:mn> </s:math> , 95% CI [0.28, 0.66]), and IBS Symptom Severity Scale ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mtext>SMD</u:mtext> <u:mo>=</u:mo> <u:mo>−</u:mo> <u:mn>0.75</u:mn> </u:math> , 95% CI [-1.04, -0.47]). Compared to dicetel ( <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mtext>RR</w:mtext> <w:mo>=</w:mo> <w:mn>1.25</w:mn> </w:math> , 95% CI [1.18, 1.32]) and trimebutine maleate ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mtext>RR</y:mtext> <y:mo>=</y:mo> <y:mn>1.35</y:mn> </y:math> , 95% CI [1.13, 1.61]), acupuncture also showed more effective at total efficiency. The more adverse effect occurred in the acupuncture group when comparing with the dicetel group ( <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mtext>RR</ab:mtext> <ab:mo>=</ab:mo> <ab:mn>11.86</ab:mn> </ab:math> , 95% CI [1.58, 89.07]) and loperamide group ( <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:mtext>RR</cb:mtext> <cb:mo>=</cb:mo> <cb:mn>4.42</cb:mn> </cb:math> , 95% CI [0.57, 33.97]), but most of the adverse reactions were mild hypodermic hemorrhage. Conclusion. Acupuncture treatment can improve the clinical effectiveness of IBS-D or FD, with great safety, but the above conclusions need to be further verified through the higher quality of evidence.