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Complementary Health Approaches for Irritable Bowel Syndrome

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Abstract

Purpose of review

Irritable bowel syndrome (IBS) is a common functional disorder with a prevalence of up to 15% in the USA. Patients with IBS are more inclined to seek complementary treatment options for management of their conditions due to a lack of sufficient relief from conventional treatments and preference towards a more natural approach. We reviewed the most up-to-date medical literature regarding complementary health modalities for the treatment of IBS.

Recent findings

Proposed mechanisms for IBS range from alterations in gut motility, intestinal permeability, intestinal microbiome, visceral hypersensitivity, and brain-gut interactions. Addressing each mechanism has helped to broaden our treatment armamentarium by introducing specific targets to different aspects of the disease mechanisms. Today, treatment options for IBS range from conventional prescription drugs for symptomatic relief, including antibiotics for IBS predominant diarrhea to complementary modalities: specific diets, probiotics, botanical herbal regimens, acupuncture, and mind-body therapies.

Summary

Numerous complementary health approaches are available to patients and gastroenterologists. There is sound evidence to support the use of such modalities to augment the care and overall quality of life of patients with IBS.

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References and Recommended Reading

  1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712–21.e4.

    PubMed  Google Scholar 

  2. Gan WC, Smith L, Luca EJ, Harnett JE. The prevalence and characteristics of complementary medicine use by Australian and American adults living with gastrointestinal disorders: a systematic review. Complement Ther Med. 2018;41:52–60.

    PubMed  Google Scholar 

  3. Drossman DA, Hasler WL. Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6):1257–61.

    PubMed  Google Scholar 

  4. Hussain Z, Quigley E. Systematic review: complementary and alternative medicine in the irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(4):465–71.

    CAS  PubMed  Google Scholar 

  5. Hung A, Kang N, Bollom A, Wolf JL, Lembo A. Complementary and alternative medicine use is prevalent among patients with gastrointestinal diseases. Dig Dis Sci. 2015;60(7):1883–8.

    PubMed  Google Scholar 

  6. Larussa T, Rossi M, Suraci E, Marasco R, Imeneo M, Abenavoli L, et al. Use of complementary and alternative medicine by patients with irritable bowel syndrome according to the Roma IV criteria: a single-center Italian survey. Medicina (Kaunas). 2019;55(2).

  7. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Rep. 2015(79):1–16.

  8. Bahrami HR, Hamedi S, Salari R, Noras M. Herbal medicines for the management of irritable bowel syndrome: a systematic review. Electron Physician. 2016;8(8):2719–25.

    PubMed  PubMed Central  Google Scholar 

  9. Ford A, Moayyedi P. Meta-analysis: factors affecting placebo response rate in the irritable bowel syndrome. Aliment Pharmacol Ther. 2010;32(2):144–58.

    CAS  PubMed  Google Scholar 

  10. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. Jama. 2015;313(9):949–58.

    CAS  PubMed  Google Scholar 

  11. •• Tap J, Derrien M, Törnblom H, Brazeilles R, Cools-Portier S, Doré J, et al. Identification of an intestinal microbiota signature associated with severity of irritable bowel syndrome. Gastroenterology. 2017;152(1):111–23.e8 This is one of the few studies that has shown identification of an intestinal microbiota signature with the severity of IBS symptoms. This may be a path to bridging the gap in our knowledge regarding the role of the gut microbiome in IBS and customized or targeted treatment with the use of diet or probiotics.

    PubMed  Google Scholar 

  12. Pittayanon R, Lau JT, Yuan Y, Leontiadis GI, Tse F, Surette M, et al. Gut microbiota in patients with irritable bowel syndrome-a systematic review. Gastroenterology. 2019;157(1):97–108.

    PubMed  Google Scholar 

  13. Wang L, Alammar N, Singh R, Nanavati J, Song Y, Chaudhary R, et al. Gut microbial dysbiosis in the irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. J Acad Nutr Diet. 2020;120(4):565–86.

    PubMed  Google Scholar 

  14. • Klem F, Wadhwa A, Prokop LJ, Sundt WJ, Farrugia G, Camilleri M, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology. 2017;152(5):1042–54.e1 Landmark systematic review of large population size for up to 10 years identifying post infectious enteritis with a significant prevalance of IBS.The study also clearly demonstrated higher risk populations emphasizing the role of immunogenicitiy, and the gut brain axis.

    PubMed  PubMed Central  Google Scholar 

  15. Litleskare S, Rortveit G, Eide GE, Hanevik K, Langeland N, Wensaas KA. Prevalence of irritable bowel syndrome and chronic fatigue 10 years after Giardia infection. Clin Gastroenterol Hepatol. 2018;16(7):1064–72.e4.

    PubMed  Google Scholar 

  16. Schwille-Kiuntke J, Mazurak N, Enck P. Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers’ diarrhoea. Aliment Pharmacol Ther. 2015;41(11):1029–37.

    CAS  PubMed  Google Scholar 

  17. Shah A, Talley NJ, Jones M, Kendall BJ, Koloski N, Walker MM, et al. Small intestinal bacterial overgrowth in irritable bowel syndrome: a systematic review and meta-analysis of case-control studies. Am J Gastroenterol. 2020;115(2):190–201.

    PubMed  Google Scholar 

  18. Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16–24.

    PubMed  PubMed Central  Google Scholar 

  19. Pimentel M, Chow EJ, Lin HC. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome. Am J Gastroenterol. 2000;95(12):3503–6.

    CAS  PubMed  Google Scholar 

  20. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (review). Int J Mol Med. 2017;40(3):607–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Muir J. An overview of fiber and fiber supplements for irritable bowel syndrome. Gastroenterol Hepatol (N Y). 2019;15(7):387–9.

    Google Scholar 

  22. Moayyedi P, Quigley EM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2014;109(9):1367–74.

    CAS  PubMed  Google Scholar 

  23. Nagarajan N, Morden A, Bischof D, King EA, Kosztowski M, Wick EC, et al. The role of fiber supplementation in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2015;27(9):1002–10.

    CAS  PubMed  Google Scholar 

  24. Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology. 2018;154(3):529–39.e2.

    CAS  PubMed  Google Scholar 

  25. Dionne J, Ford AC, Yuan Y, Chey WD, Lacy BE, Saito YA, et al. A systematic review and meta-analysis evaluating the efficacy of a gluten-free diet and a low FODMAPs diet in treating symptoms of irritable bowel syndrome. Am J Gastroenterol. 2018;113(9):1290–300.

    CAS  PubMed  Google Scholar 

  26. Irvine AJ, Chey WD, Ford AC. Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol. 2017;112(1):65–76.

    PubMed  Google Scholar 

  27. Gravina AG, Dallio M, Romeo M, Di Somma A, Cotticelli G, Loguercio C, et al. Adherence and effects derived from FODMAP diet on irritable bowel syndrome: a real life evaluation of a large follow-up observation. Nutrients. 2020;12(4).

  28. Ford AC, Lacy BE, Talley NJ. Irritable bowel syndrome. N Engl J Med. 2017;376(26):2566–78.

    CAS  PubMed  Google Scholar 

  29. Ford AC, Moayyedi P, Chey WD, Harris LA, Lacy BE, Saito YA, et al. American College of Gastroenterology monograph on management of irritable bowel syndrome. Am J Gastroenterol. 2018;113(Suppl 2):1–18.

    PubMed  Google Scholar 

  30. Werlang ME, Palmer WC, Lacy BE. Irritable bowel syndrome and dietary interventions. Gastroenterol Hepatol (N Y). 2019;15(1):16–26.

    Google Scholar 

  31. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25(8):1366–73.

    CAS  PubMed  Google Scholar 

  32. Zhou SY, Gillilland M 3rd, Wu X, Leelasinjaroen P, Zhang G, Zhou H, et al. FODMAP diet modulates visceral nociception by lipopolysaccharide-mediated intestinal inflammation and barrier dysfunction. J Clin Invest. 2018;128(1):267–80.

    PubMed  Google Scholar 

  33. Staudacher HM, Whelan K. The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut. 2017;66(8):1517–27.

    CAS  PubMed  Google Scholar 

  34. Staudacher HM, Lomer MCE, Farquharson FM, Louis P, Fava F, Franciosi E, et al. A diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and a probiotic restores Bifidobacterium species: a randomized controlled trial. Gastroenterology. 2017;153(4):936–47.

    CAS  PubMed  Google Scholar 

  35. Bellini M, Tonarelli S, Nagy AG, Pancetti A, Costa F, Ricchiuti A, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020;12(1).

  36. Hill P, Muir JG, Gibson PR. Controversies and recent developments of the low-FODMAP diet. Gastroenterol Hepatol (N Y). 2017;13(1):36–45.

    Google Scholar 

  37. Eswaran S, Dolan RD, Ball SC, Jackson K, Chey W. The impact of a 4-week low-FODMAP and mNICE diet on nutrient intake in a sample of US adults with irritable bowel syndrome with diarrhea. J Acad Nutr Diet. 2020;120(4):641–9.

    PubMed  Google Scholar 

  38. Curro D, Ianiro G, Pecere S, Bibbo S, Cammarota G. Probiotics, fibre and herbal medicinal products for functional and inflammatory bowel disorders. Br J Pharmacol. 2017;174(11):1426–49.

    CAS  PubMed  Google Scholar 

  39. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044–60.

    PubMed  Google Scholar 

  40. Agrawal A, Houghton LA, Morris J, Reilly B, Guyonnet D, Goupil Feuillerat N, et al. Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with constipation. Aliment Pharmacol Ther. 2009;29(1):104–14.

    CAS  PubMed  Google Scholar 

  41. Andresen V, Gschossmann J, Layer P. Heat-inactivated Bifidobacterium bifidum MIMBb75 (SYN-HI-001) in the treatment of irritable bowel syndrome: a multicentre, randomised, double-blind, placebo-controlled clinical trial. Lancet Gastroenterol Hepatol. 2020;5:658–66.

    PubMed  Google Scholar 

  42. Wen Y, Li J, Long Q, Yue CC, He B, Tang XG. The efficacy and safety of probiotics for patients with constipation-predominant irritable bowel syndrome: a systematic review and meta-analysis based on seventeen randomized controlled trials. Int J Surg. 2020;79:111–9.

    PubMed  Google Scholar 

  43. Li B, Liang L, Deng H, Guo J, Shu H, Zhang L. Efficacy and safety of probiotics in irritable bowel syndrome: a systematic review and meta-analysis. Front Pharmacol. 2020;11:332.

    PubMed  PubMed Central  Google Scholar 

  44. Su GL, Ko CW, Bercik P, Falck-Ytter Y, Sultan S, Weizman AV, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology. 2020;159(2):697–705.

    CAS  PubMed  Google Scholar 

  45. Ianiro G, Eusebi LH, Black CJ, Gasbarrini A, Cammarota G, Ford AC. Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50(3):240–8.

    PubMed  Google Scholar 

  46. Myneedu K, Deoker A, Schmulson MJ, Bashashati M. Fecal microbiota transplantation in irritable bowel syndrome: a systematic review and meta-analysis. United European Gastroenterol J. 2019;7(8):1033–41.

    PubMed  PubMed Central  Google Scholar 

  47. Wang Y, Zheng F, Liu S, Luo H. Research progress in fecal microbiota transplantation as treatment for irritable bowel syndrome. Gastroenterol Res Pract. 2019;2019:9759138.

    PubMed  PubMed Central  Google Scholar 

  48. El-Salhy M, Hatlebakk JG, Gilja OH, Bråthen Kristoffersen A, Hausken T. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut. 2020;69(5):859–67.

    CAS  PubMed  Google Scholar 

  49. Alammar N, Wang L, Saberi B, Nanavati J, Holtmann G, Shinohara RT, et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019;19(1):21.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Hawrelak JA, Wohlmuth H, Pattinson M, Myers SP, Goldenberg JZ, Harnett J, et al. Western herbal medicines in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Complement Ther Med. 2020;48:102233.

    PubMed  Google Scholar 

  51. Weerts Z, Masclee AAM, Witteman BJM, Clemens CHM, Winkens B, Brouwers J, et al. Efficacy and safety of peppermint oil in a randomized, double-blind trial of patients with irritable bowel syndrome. Gastroenterology. 2020;158(1):123–36.

    CAS  PubMed  Google Scholar 

  52. Fifi AC, Axelrod CH, Chakraborty P, Saps M. Herbs and spices in the treatment of functional gastrointestinal disorders: a review of clinical trials. Nutrients. 2018;10(11).

  53. Madisch A, Holtmann G, Plein K, Hotz J. Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial. Aliment Pharmacol Ther. 2004;19(3):271–9.

    CAS  PubMed  Google Scholar 

  54. Di Pierro F, Bertuccioli A, Giuberti R, Saponara M, Ivaldi L. Role of a berberine-based nutritional supplement in reducing diarrhea in subjects with functional gastrointestinal disorders. Minerva Gastroenterol Dietol. 2020;66(1):29–34.

    PubMed  Google Scholar 

  55. Chen C, Tao C, Liu Z, Lu M, Pan Q, Zheng L, et al. A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytother Res. 2015;29(11):1822–7.

    CAS  PubMed  Google Scholar 

  56. Ng QX, Soh AYS, Loke W, Venkatanarayanan N, Lim DY, Yeo W-S. A meta-analysis of the clinical use of curcumin for irritable bowel syndrome (IBS). J Clin Med. 2018;7(10):298.

    CAS  PubMed Central  Google Scholar 

  57. Di Ciaula A, Portincasa P, Maes N, Albert A. Efficacy of bio-optimized extracts of turmeric and essential fennel oil on the quality of life in patients with irritable bowel syndrome. Ann Gastroenterol. 2018;31(6):685–91.

    PubMed  PubMed Central  Google Scholar 

  58. Storsrud S, Ponten I, Simren M. A pilot study of the effect of Aloe barbadensis Mill. extract (AVH200(R)) in patients with irritable bowel syndrome: a randomized, double-blind, placebo-controlled study. J Gastrointestin Liver Dis. 2015;24(3):275–80.

    PubMed  Google Scholar 

  59. Davis K, Philpott S, Kumar D, Mendall M. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. Int J Clin Pract. 2006;60(9):1080–6.

    CAS  PubMed  Google Scholar 

  60. Hutchings HA, Wareham K, Baxter JN, Atherton P, Kingham JG, Duane P, et al. A randomised, cross-over, placebo-controlled study of Aloe vera in patients with irritable bowel syndrome: effects on patient quality of life. ISRN Gastroenterol. 2011;2011:206103.

    CAS  PubMed  Google Scholar 

  61. Hong SW, Chun J, Park S, Lee HJ, Im JP, Kim JS. Aloe vera is effective and safe in short-term treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Neurogastroenterol Motil. 2018;24(4):528–35.

    PubMed  PubMed Central  Google Scholar 

  62. Rizzello F, Ricci C, Scandella M, Cavazza E, Giovanardi E, Valerii MC, et al. Dietary geraniol ameliorates intestinal dysbiosis and relieves symptoms in irritable bowel syndrome patients: a pilot study. BMC Complement Altern Med. 2018;18(1):338.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Zhou Q, Verne ML, Fields JZ, Lefante JJ, Basra S, Salameh H, et al. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019;68(6):996–1002.

    CAS  PubMed  Google Scholar 

  64. Chen M, Tang TC, Wang Y, Shui J, Xiao XH, Lan X, et al. Randomised clinical trial: Tong-Xie-Yao-Fang granules versus placebo for patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(2):160–8.

    CAS  PubMed  Google Scholar 

  65. Zhu J-J, Liu S, Su X-L, Wang Z-S, Guo Y, Li Y-J, et al. Efficacy of Chinese herbal medicine for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials. Evid Based Complement Alternat Med. 2016;2016:1–15.

    CAS  Google Scholar 

  66. Windgassen S, Moss-Morris R, Chilcot J, Sibelli A, Goldsmith K, Chalder T. The journey between brain and gut: a systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. Br J Health Psychol. 2017;22(4):701–36.

    PubMed  Google Scholar 

  67. Radu M, Moldovan R, Pintea S, Băban A, Dumitrascu D. Predictors of outcome in cognitive and behavioural interventions for irritable bowel syndrome. A meta-analysis. J Gastrointestin Liver Dis. 2018;27(3):257–63.

    PubMed  Google Scholar 

  68. Yan J, Miao ZW, Lu J, Ge F, Yu LH, Shang WB, et al. Acupuncture plus Chinese herbal medicine for irritable bowel syndrome with diarrhea: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:7680963.

    PubMed  PubMed Central  Google Scholar 

  69. Sagan C The demon-haunted world: science as a candle in the dark. Quote Page 187, Ballantine Books, New York. Verified with Amazon Look Inside for 1997, Ballantine Books paperback edition.

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Funding

This research received no external funding but was supported by a gift by Alexander and Valentina Severinsky.

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Dr. Asamoah conducted a literature review and drafted the manuscript. Dr. Mullin provided oversight, review of drafts, and editorial contributions.

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Correspondence to Gerard Mullin MD.

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Vivian A. Asamoah declares that she has no potential conflict of interest.

Gerard Mullin declares that he has no potential conflicts of interest.

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Asamoah, V.A., Mullin, G. Complementary Health Approaches for Irritable Bowel Syndrome. Curr Treat Options Gastro 18, 545–556 (2020). https://doi.org/10.1007/s11938-020-00315-w

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