Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis

Lingping Zhu, Yunhui Ma, Shasha Ye, Zhiqun Shu, Lingping Zhu, Yunhui Ma, Shasha Ye, Zhiqun Shu

Abstract

Background: The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture, and drugs in the treatment of diarrhoea-predominant irritable bowel syndrome.

Methods: Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database, and CBM) up to December 2017. Additional references were obtained from review articles. With document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework.

Results: A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3.

Conclusion: Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.

Figures

Figure 1
Figure 1
Identification process for eligible trials.
Figure 2
Figure 2
The Forest plot of IBS-D treatment of acupuncture compared with other drugs. A: acupuncture; B: eluxadoline; C: pinaverium bromide; D: alosetron E: ramosetron; F: rifaximin; G: sham acupuncture; H: placebo.
Figure 3
Figure 3
The cumulative probability ranking plot of treatment effect of acupuncture and other drugs on IBS-D.
Figure 4
Figure 4
The cumulative probability ranking plot of side effect of drugs on IBS-D.
Figure 5
Figure 5
The network plot of all treatment methods: yellow means the low-quality studies, green means the high-quality studies.
Figure 6
Figure 6
Brooks-Gelman-Rubin diagnostic plot of included studies.
Figure 7
Figure 7
Density plot of included studies.
Figure 8
Figure 8
Node-splitting plot of included studies.
Figure 9
Figure 9
The cumulative contribution plot of IBS-D treatment of acupuncture compared with other drugs. ACU: acupuncture; ELU: eluxadoline; PIN: pinaverium bromide; ALO: alosetron; RAM: ramosetron; RIF: rifaximin; SHAM: sham acupuncture; PLA: placebo.
Figure 10
Figure 10
The heterogeneity analysis of included studies. A: acupuncture; B: eluxadoline; C: pinaverium bromide; D: alosetron; E: ramosetron; F: rifaximin; G: sham acupuncture; H: placebo.
Figure 11
Figure 11
The funnel plot of all included studies. ACU: acupuncture; ELU: eluxadoline; PIN: pinaverium bromide; ALO: alosetron; RAM: ramosetron; RIF: rifaximin; SHAM: sham acupuncture; PLA: placebo.

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