OBJECTIVE:To compare the efficacy differences between abdominal acupuncture and western medication for diarrhea irritable bowel syndrome (IBS-D).

METHODS:Sixty-one patients with IBS-D were randomly assigned into an acupuncture group (30 cases after 1 dropping) and a western medication group (28 cases after 2 dropping). Acupuncture was used at Yinqiguiyuan points [Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Guanyuan (CV 4)], Fusiguan points [bilateral Huaroumen (ST 24), Wailing (ST 26)], Tiaopiqi point [bilateral Daheng (SP 15)], once every other day, 3 times a week. Pinaverium bromide tablet was used orally in the western medication group, 50 mg a time, 3 times a day. All the treatment was given for 4 weeks in the two groups. IBS symptom severity score (IBS-SSS) and clinical symptom scores for abdominal pain and distension, diarrhea, poor stool output, defecation urgency and stool abnormality were observed before and after the treatment as well as 3 months after treatment. Adverse reactions were recorded and the effects were evaluated.

RESULTS:①After treatment and at follow-up, the IBS-SSS scores of the two groups were lower than those before treatment (all P<0.01). Compared with the western medication group, the scores and the improvements between the two time points and before treatment were better in the acupuncture group (P<0.05, P<0.01).②The symptom scores in the two groups after treatment were lower than those before treatment including abdominal pain, abdominal distension, diarrhea, poor stool output, defecation urgency and stool abnormality (P<0.05, P<0.01), and the scores of abdominal pain, abdominal distension, diarrhea, poor stool output and stool abnormality in the acupuncture group were lower than those in the western medication group (P<0.05, P<0.01).③The total effective rate and the cured and remarkable effective rate of the acupuncture group were higher than those of the western medication group [(86.7% (26/30) vs 64.3% (18/28), P<0.05; 70.0% (21/30) vs 35.7% (10/28), P<0.01)], and the therapeutic efficacy of the acupuncture group was better than that of the western medication group (P<0.05). There was no adverse reaction.

CONCLUSION:Abdominal acupuncture is more effective for IBS-D than western medication and can relieve abdominal pain, abdominal distension, diarrhea, poor stool output, stool abnormality, with long-term effect.

Aim. To compare whether there is different effect between electroacupuncture (EA) and moxibustion (Mox) on visceral hypersensitivity (their analgesic effects) in constipation-predominant irritable bowel syndrome (C-IBS). Methods. EA at 1 mA and 3 mA and Mox at 43°C and 46°C were applied to the Shangjuxu (ST37, bilateral) acupoint in rats with C-IBS and normal rats. An abdominal withdrawal reflex (AWR) score was used to assess visceral hypersensitivity. Toluidine blue staining was used to assess mast cell (MC) activity in colon of rats. Immunochemistry was used to measure 5-HT and 5-HT4 receptor expression in the colon. Results. AWR scores in all EA (1 mA and 3 mA) and Mox (43°C and 46°C) treatment groups after colorectal distention (CRD) stimulation pressure of 20, 40, 60, and 80 mmHg were significantly lower than those of the model (MC) group (P all<0.01). The MC counts and degranulation rates in the colon of all EA and Mox treatment groups and the MC group were significantly higher than those of the NC group (P all<0.01). MC degranulation rates in the colon of all EA and Mox treatment groups were lower than those of the MC group (P all<0.05). 5-HT expression in colon of all EA and Mox treatment groups was significantly lower than that of the MC group (P all<0.01), and 5-HT4R expression in colon of both EA groups was significantly higher than that of the MC group (P both<0.01). Conclusion. EA and Mox treatments may both ameliorate visceral hypersensitivity at different degree in rats with C-IBS, and EA treatment was better than Mox.

BACKGROUND:Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.

METHODS:Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.

RESULTS:In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P<0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).

CONCLUSIONS:A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

OBJECTIVE:To investigate the effect of electroacupuncture(EA)stimulation of sensitized acupoints on bowel dysfunction in diarrhea-predominant irritable bowel syndrome(D-IBS)rats.

METHODS:Fifty SD rats were randomly divided into control, model, EA sensitized acupoint and EA non-sensitized acupoint groups, with 20 rats in the model group and 10 rats in each of the other 3 groups. The D-IBS model was established by chronic restraint stress and intragastric administration of folium sennae (0.3 g/mL, 10 mL/kg), once daily for 2 weeks, followed by two weeks' restraint stress stimulation. The sensitized acupoints were determined by locating the extravasation points of Evans Blue (EB) dye after tail-intravenous injection, and stimulated with EA (2 mA, 2 Hz) for 30 min, once daily for 7 consecutive days. For rats of the EA non-sensitized acupoint group, bilateral BL 15 were stimulated with the same parameters and same stimulation duration. The rats' bowel mobility was evaluated by Bristol stool scale (BSS), loose stools rate and diarrhea index.

RESULTS:After modeling, the BSS, loose stool rate, and diarrhea index were significantly increased in the model group relevant to the control group (P<0.05). After the treatment, the BSS, loose stool rate, and diarrhea index on day 7 were considerably lowered in the EA-BL 25 group (P<0.05) but not in EA-BL15 group (P<0.05), suggesting a better therapeutic effect of EA of the sensitized acupoint. No significant changes were found in the abovementioned 3 indexes on day 4 after the treatment relevant to the model group (P<0.05).

CONCLUSIONS:EA stimulation of the sensitized acupoint can improve diarrhea in D-IBS rats.

BACKGROUND & AIMS:This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS.

METHODS:MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations.

RESULTS:Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear.

CONCLUSIONS:The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS.

BACKGROUND & AIMS:This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS.

METHODS:MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations.

RESULTS:Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear.

CONCLUSIONS:The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS.

The purpose of this study was to examine the effect of auricular acupressure on bowel symptoms, stress, mental health, and heart rate variability in women with irritable bowel syndrome (IBS). A quasi-experimental study design with a nonequivalent control group assessed a total sample of 56 women diagnosed with IBS according to Rome III criteria. There were 29 women in the experimental group who received auricular acupressure; 27 women were in the control group. Semen sinapis albae seeds were used to administer acupressure to four auricular points: endocrine, large intestine, lung, and Shenmen for 5 days/week for 4 weeks; the control group received no treatment. Bowel symptoms, stress, mental health, and heart rate variability were measured twice, once before and once after the intervention. Chi-square tests, t tests, and paired t tests were used for analysis. The experimental group had decreased loose stools, abdominal pain, diarrhea, abdominal discomfort, stress, and heart rate variability compared with the control group (p<.05). Auricular acupressure was effective for symptom improvement in patients with IBS.

BACKGROUND:To examine whether electro-acupuncture (EA) could decrease 5-hydroxytryptamine (5-HT) and calcitonin gene-related peptide (CGRP), and increase neuro-peptide Y (NPY) in the brain-gut axis (BGA) in D-IBS using rat models.

METHODS:Rats were randomly exposed to unpredictable chronic stress for 3 weeks followed by 1-hour acute restraint stress (CAS) after 7 days of rest, or daily gavage of Senna decoction (6 g/kg) plus chronic restraint stress (for a duration of 2 h, starting from 1 h prior to the gavage) for 2 weeks (ISC). The content of 5-HT, CGRP and NPY in the distal colon, spinalcord, hypothalamus was examined at the end of the treatment.

RESULTS:1. The two rat models exhibited similar characteristics, e.g., increased number of fecal pellets expelled in 1 h, decreased sacchar-intake, decreased CRD, elevated 5-HT, CGRP content and decreased NPY in the distal colon, spinal cord, hypothalamus (P < 0.05 vs. that in healthy control rats). 2. A series of equations was developed based on correlation regression analysis. The analysis results demonstrated that 5-HT mediates the changes in hypothalamus, spinal cord and colon. 5-HT and CGRP in spinal cord was closely correlated with general behavior evaluation and other transmitters in BGA.

CONCLUSION:1. In comparison to 5-HT, CGRP and NPY (particularly in the spinal cord) had closer relationship with the D-IBS symptoms induced by either stress factors or Senna decotion. 2. EA treatment could restore the brain-gut axis to balanced levels.

Irritable bowel syndrome (IBS) global burden is underestimated despite its high prevalence. It's a gastrointestinal disease having obscure pathophysiology with multiple therapies yet unsatisfactory remedies. The Endocannabinoid system (ECS) of our body plays a key role in maintaining normal physiology of the gastrointestinal tract as well as involves abnormalities including functional diseases like IBS. This review highlights the importance of the Endocannabinoid system, its connections with the normal gastrointestinal functions and abnormalities like IBS. It also discusses the role of cannabis as medical therapy in IBS patients. A literature search for articles related to endocannabinoids in IBS and medical cannabis in PubMed and Google Scholar was conducted. The studies highlighted the significant participation of ECS in IBS. However, the breach in obtaining the promising therapeutic model for IBS needed further investigation in ECS and uncover other treatments for IBS. This review summarizes ECS, highlights the relationship of ECS with IBS and explores cannabis as a potential therapy to treat IBS.

BACKGROUND:As drug use has limitations in the treatment of irritable bowel syndrome (IBS), increasing attention is being paid to nondrug therapies and complementary treatments, especially exercise. It is known that bowel movements are more frequent and colon transit is more rapid in physically active individuals than in sedentary individuals. However, the effects of exercise on IBS are unclear.

PURPOSE:We conducted a systematic review to assess the effects of exercise on IBS.

METHODS:We searched PubMed, Web of Science, EMBASE, Cochrane Library, and two Chinese databases (Wanfang Database and Chinese Biomedical Literature [CBM]) for eligible studies. We extracted and pooled relevant information regarding the effects of exercise in patients with IBS. The primary outcomes were gastrointestinal symptoms, quality of life, depression, and anxiety.

KEY RESULTS:A total of 683 patients with IBS from 14 randomized controlled trials met our inclusion criteria. The exercise interventions in this review were yoga, walking/aerobic physical activity, Tai Ji, mountaineering, and Baduanjin qigong activity. The results of this review suggested exercise had significant benefits for patients with IBS, but studies were limited by the strong risk of bias.

CONCLUSIONS AND INFERENCES:Our findings suggest that exercise is potentially a feasible and effective treatment for IBS patients. However, because of methodologic issues, no firm conclusions could be drawn about the true effects of this intervention. Researchers should design a rigorous study to assess the effects of exercise on IBS.

Food intolerance in irritable bowel syndrome (IBS) is increasingly being recognized, with patients convinced that diet plays a role in symptom induction. Evidence is building to implicate fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the onset of abdominal pain, bloating, wind and altered bowel habit through their fermentation and osmotic effects. Hypersensitivity to normal levels of luminal distension is known to occur in patients with IBS, with consideration of food chemical intolerance likely to answer many questions about this physiological process. This paper summarizes the evidence and application of the most common approaches to managing food intolerance in IBS: the low-FODMAP diet, the elimination diet for food chemical sensitivity and others including possible noncoeliac gluten intolerance.

Celiac disease is increasingly recognized autoimmune enteropathy caused by a permanent gluten intolerance. Gluten is the main storage protein of wheat, in genetically predisposed individuals. Celiac disease risk in first degree relatives is about 10%. Diarrhea and changes of bowel movement, observed as well in celiac disease as in IBS, may lead to misdiagnosis of IBS basing on the Rome criteria or may be associated with coexistence of both diseases. The aim of the study was to assess the celiac disease prevalence in patients with irritable bowel syndrome. The study group comprised 200 patients (120 women and 80 men) aged 18-78 years (mean: 46.7 years) with diarrhoeal form of irritable bowel syndrome (IBS), according to the Rome criteria II. At the beginning and after a three month period anti tissue transglutaminase antibodies (IgA tTG) were estimated. Gastroscopy with biopsy where performed in those with IgA tTG titre above 1/200. 40 patients were immunologically positive and 14 of them have histopathologically proven celiac disease. In the group of patients with detected celiac disease, gluten free diet was applied besides the treatment with trimebutin or mebewerin, recommended for IBS. After 6 months the decrease of IgA tTG titre in the serum was observed. In 5 of these patients IgA tTG level was negative. It was associated with the significant decrease of clinical symptoms, such as diarrhea and flatulence. The remaining symptoms, such as abdominal pain, feeling of incomplete defecation demanded continuation of IBS treatment. With regard to often atypical celiac disease symptoms--adult active searching should be performed to differentiate from irritable bowel syndrome.

Abstract This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind-Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p<.001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.

BACKGROUND:Approximately two thirds of patients with irritable bowel syndrome (IBS) respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we have previously developed and validated a method of presenting colors to individuals for research purposes called the Manchester Color Wheel (MCW). Using this instrument we have been able to classify colors into positive, neutral and negative shades and this study aimed to assess their predictive role in hypnotherapy.

METHODS:156 consecutive IBS patients (aged 14-74, mean 42.0 years, 127 (81%) females, 29 (19%) males) were studied. Before treatment, each patient was asked to relate their mood to a color on the MCW as well as completing the IBS Symptom Severity Score, the Hospital Anxiety and Depression (HAD) Scale, the Non-colonic Symptom Scale, the Quality of Life Scale and the Tellegen Absorption Scale (TAS) which is a measure of hypnotisability. Following hypnotherapy all these measures were repeated with the exception of the TAS.

RESULTS:For patients with a positive mood color the odds of responding to hypnotherapy were nine times higher than that of those choosing either a neutral or negative color or no color at all (odds ratio: 8.889; p = 0.042). Furthermore, a high TAS score and the presence of HAD anxiety also had good predictive value (odds ratio: 4.024; p = 0.092, 3.917; p<0.001 respectively) with these markers and a positive mood color being independent of each other. In addition, these factors could be combined to give an even stronger prediction of outcome. Twice as many responders (63, 77.8%) had a positive mood color or were anxious or had a high TAS score compared with 32 (42.7%) without these factors (p<0.001).

CONCLUSION:A positive mood color, especially when combined with HAD anxiety and a high TAS score, predict a good response to hypnotherapy.

BACKGROUND:Placebo treatment can significantly influence subjective symptoms. However, it is widely believed that response to placebo requires concealment or deception. We tested whether open-label placebo (non-deceptive and non-concealed administration) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome (IBS).

METHODS:Two-group, randomized, controlled three week trial (August 2009-April 2010) conducted at a single academic center, involving 80 primarily female (70%) patients, mean age 47± 18 with IBS diagnosed by Rome III criteria and with a score ≥ 150 on the IBS Symptom Severity Scale (IBS-SSS). Patients were randomized to either open-label placebo pills presented as"placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes"or no-treatment controls with the same quality of interaction with providers. The primary outcome was IBS Global Improvement Scale (IBS-GIS). Secondary measures were IBS Symptom Severity Scale (IBS-SSS), IBS Adequate Relief (IBS-AR) and IBS Quality of Life (IBS-QoL).

FINDINGS:Open-label placebo produced significantly higher mean (±SD) global improvement scores (IBS-GIS) at both 11-day midpoint (5.2 ± 1.0 vs. 4.0 ± 1.1, p<.001) and at 21-day endpoint (5.0± 1.5 vs. 3.9 ± 1.3, p = .002). Significant results were also observed at both time points for reduced symptom severity (IBS-SSS, p = .008 and p = .03) and adequate relief (IBS-AR, p = .02 and p = .03); and a trend favoring open-label placebo was observed for quality of life (IBS-QoL) atthe 21-day endpoint (p = .08).

CONCLUSION:Placebos administered without deception may be an effective treatment for IBS. Further research is warranted in IBS, and perhaps other conditions, to elucidate whether physicians can benefit patients using placebos consistent with informed consent.

TRIAL REGISTRATION:ClinicalTrials.gov NCT01010191.

BACKGROUND: Evidence supports the effectiveness of cognitive behavioural approaches in improving the symptoms of the irritable bowel syndrome (IBS). Duration, cost and resistance of many patients towards a psychological therapy have limited their acceptance. AIM: To evaluate the effectiveness of a psycho-educational intervention on IBS symptoms.

METHODS: Sixty-nine IBS patients (72% female) were randomised to an intervention or a wait-list control group. The IBS class consisted of education on a biological mind body disease model emphasising self-efficacy and practical relaxation techniques.

RESULTS: Patients in the intervention showed significant improvement on GI symptom severity, visceral sensitivity, depression and QoL postintervention and most of these gains were maintained at 3-month follow-up (Hedge's g = -0.46-0.77). Moderated mediation analyses indicated change in anxiety, visceral sensitivity, QoL and catastrophising due to the intervention had moderate mediation effects (Hedge's g = -0.38 to -0.60) on improvements in GI symptom severity for patients entering the trial with low to average QoL. Also, change in GI symptom severity due to the intervention had moderate mediation effects on improvements in QoL especially in patients with low to average levels of QoL at baseline. Moderated mediation analyses indicated mediation was less effective for patients entering the intervention withhigh QoL.

CONCLUSIONS: A brief psycho-educational group intervention is efficacious in changing cognitions and fears about the symptoms of the irritable bowel syndrome, and these changes are associated with clinically meaningful improvement in symptoms and quality of life. The intervention seems particularly tailored to patients with low to moderate quality of life baseline levels.

Abstract Background In diseases defined primarily by the subjective nature of patient self-report, placebo effects can overwhelm the capacity of randomized controlled trials to detect medication-placebo differences. Moreover, it is unclear whether such placebo effects represent genuine psychobiological phenomena or just shifts in selective attention. Knowledge of predictors of the placebo response could improve the design of clinical trials and the delivery of personalized medical care. Methods In patients with irritable bowel syndrome (IBS), a subset of our previous study that were randomized to placebo treatment (sham acupuncture) or no-treatment group (waitlist), we tested an enriched panel of 10 serum biomarkers at the enrolment and the 3rd week of intervention, using a multiplex electrochemiluminescent immunoassay. Key Results More pronounced changes overtime in serum levels of osteoprotegerin (OPG) have been found in patients who received placebo treatment compared with the waitlist group (P = 0.039). Moreover, serum levels of OPG at baseline were found to be higher (P = 0.0167) in patients who subsequently achieved adequate relief (AR) of their IBS symptoms, independently of their treatment group. Besides, serum levels of TNF-related weak inducer of apoptosis (TWEAK) at baseline were also higher (P = 0.0144) in patients who reported AR and in particular in those who received the placebo treatment. Conclusions&Inferences These two measurable biological parameters associated with placebo, namely serum OPG and TWEAK, provide a proof of principle for discovering putative molecular signatures of placebo response in IBS and perhaps in other illnesses with patient self-reported outcomes.