Irritable Bowel Syndrome
The term IBS is used to describe chronic colon problems that occur in the absence of an identifiable medical cause. Common symptoms include alternating diarrhea and constipation, excess intestinal gas, intestinal cramping, uncomfortable bowel movements, abdominal discomfort following meals, and excessive awareness of the presence of stool in the colon. Despite all these distressing symptoms, in IBS, the intestines appear to be perfectly healthy when they are examined. Thus the condition belongs to a category of diseases that physicians call “functional.” This means that while the function of the bowel seems to have gone awry, no injury or disturbance of its structure can be discovered. (The analogous problem in the stomach is called dyspepsia, and the two conditions frequently overlap.)
Because the cause of IBS is not understood, conventional medical treatment of IBS is highly inadequate. One drug that had shown promise, Zelnorm, was withdrawn from the market for safety issues. Another, Lotronex, was temporarily withdrawn, and then re-approved, but only under strict limitations. Other medical treatment approaches for IBS include increased dietary fiber, drugs that reduce bowel spasm, and drugs to address constipation or diarrhea as needed. In addition, various forms of psychotherapy, including hypnosis, have been tried, with some success.1-6
Principal Proposed Natural Treatments
Peppermint oil is widely used for IBS, and the evidence suggests that it is probably useful. A majority of placebo-controlled studies have found peppermint oil to be more effective than placebo.7-12,34,49,64,67 However, most of these studies are small.
For more information, including dosage and safety issues, see the full Peppermint article.
For example, in a 6-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, in which constipation is a more significant symptom than diarrhea, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency.50 Another study examined the effects of 4 weeks of treatment with L. plantarum on intestinal gas in 60 people with IBS. This study found benefits that persisted for an entire year after treatment stopped.15 In a review of 3 randomized trials, Lactobacillus rhamnosus GG was associated with improvement in symptoms, especially a reduction in abdominal pain, among 393 children with IBS.72
In another randomized trial, 266 women with constipation who consumed yogurt containing B. animalis and the prebiotic fructo-oligosaccharide twice daily for two weeks experienced significant improvement in their symptoms compared to women consuming regular yogurt as a placebo.60
And finally, a 4-week randomized trial involving 122 people with IBS found evidence that B. bifidum improved symptoms and quality of life compared to placebo.78
Benefits have also been seen in other smaller, double-blind trials, as well, using Lactobacillus plantarum,25, 27L. acidophilus,16,55L. rhamnosus,47L. salivarus,51,63 and B. infantis,51 as well as proprietary probiotic combinations including various strains.28,35,54,62 One such combination, called VSL#3, contains B. longum, B. infantis, L. acidophilus, L. plantarum, L. casei, L. bulgaricus, and Streptococcus thermophilus. In a double-blind, crossover trial, 59 children aged 5-18 years old were randomized to receive VSL#3 or placebo for 6 weeks.69 After a 2-week "wash-out" period, the children were switched to the other treatment. VSL#3 was associated with a reduction in symptoms, including abdominal pain, bloating, and gas.
Of course, not all studies have supported the use of probiotics as a treatment for IBS.26,36,57 One randomized trial involving 90 people with diarrhea-predominant IBS found Saccharomyces boulardii to be more effective than placebo at improving quality of life.70 But, the probiotic did not seem to improve the actual symptoms of IBS. Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective.58,59
Lactobacillus plantarum 299v failed to provide significant improvements in abdominal pain, bloating, or quality of life when compared to placebo in a randomized trial with 81 adults over an 8 week period.83
Probiotics Lactobacillus, Bifidobacterium, Escherichia, and Streptococcus (alone or in combination) were evaluated in a review of 37 randomized trials. Priobiotics were associated with fewer global symptoms, abdominal pain, bloating, and flatulence when compared to placebo. There were no differences found in urgency-related symptoms. Although probiotic therapy appears effective, the right combination of strains remains unknown.82
For more information, see the full Probiotics article.
In a double-blind study, 55 people with chronic constipation caused by IBS received either ground flaxseed or psyllium seed (a well-known treatment for constipation) daily for 3 months.17 Those taking flaxseed had significantly fewer problems with constipation, abdominal pain, and bloating than those taking psyllium. The flaxseed group had even further improvements in constipation and bloating while continuing their treatment in the 3 months after the double-blind study ended. The researcher concluded that flaxseed relieved constipation more effectively than psyllium.
For more information, see the Flaxseed article.
Chinese Herbal Medicine TOP
Chinese herbal medicine is traditionally practiced in a highly individualized way, with herbal formulas tailored to the exact details of each person’s case. In a double-blind, placebo-controlled trial, 116 people with IBS were randomly assigned to receive individualized Chinese herbal treatment, a “one-size-fits-all” Chinese herbal formulation, or placebo.29 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the “generic” treatment. Similar results were seen in another study as well.44
In a review of 19 randomized trials with 1,510 people, Chinese herbal medicine was associated with a greater cure rate, and reduced recurrence of constipation-dominant IBS compared to traditional Western treatments. The Chinese herbal medicines focused on the liver and were given over a period of 3-12 weeks. However, there were many biases in the trials, which makes outcomes less reliable.80
Chinese herbal medicine significiantly improved symptoms in people with constipation-related IBS in one randomized trial. Extracts from seven herbs (or placebo) were given to 125 adults in a randomized trial and taken for 8 weeks. However, the improvement in IBS symptoms faded during the 16 weeks follow up period after treatment was stopped. There were no differences between those who took the herbal medication or the placebo in the follow up.85
For more information on this complex medical system, including important safety issues, see the Traditional Chinese Herbal Medicine article.
Other Proposed Natural Treatments TOP
One study found evidence that pancreatic digestive enzymes (including proteolytic enzymes plus other enzymes called lipases) might be helpful for reducing the flare-up of IBS symptoms that may follow a fatty meal.30
Three small studies suggest that use of the supplement melatonin might reduce symptoms of IBS;38-39,46 it has been suggested that the hormone melatonin may have an effect on the nervous system in the digestive tract.
The prebiotic supplement fructo-oligosaccharides has been advocated as a treatment for IBS. However, research results are currently inconsistent at best. For example, a s6-week, double-blind study of 105 people with mild irritable bowel syndrome compared 5 g of fructo-oligosaccharides daily against placebo, and returned conflicting results.52 According to some measures of symptom severity employed by the researchers, use of FOS led to an improvement in symptoms; however, according to other measures, FOS actually worsened symptoms.19 Conflicting results, though of a different kind, were also seen in a 12-week, double-blind, placebo-controlled study of 98 people.41 Treatment with FOS at a dose of 20 g daily initially worsened symptoms, but over time this negative effect wore off. At no time in the study were clear benefits seen, however. On a positive note, one study did find benefit with a combination prebiotic-probiotic formula.42
Hypnotherapy has shown some promise for IBS.31,75,76,77 In one trial, 90 people with IBS were randomized to receive hypnotherapy provided by an experienced psychologist or supportive therapy.75 In a second related trial, 48 patients were randomized to hypnotherapy with a less experienced psychologist or to a waiting list. In both trials, which lasted three months, those who received hypnotherapy showed an improvement in their IBS symptoms. In another trial, the addition of hypnotherapy to supportive talks and usual care improved IBS symptoms when compared to supportive talks and usual care alone in a randomized trial of 100 adults suffering from severe IBS. Over 54% of patients receiving hypnotherapy had symptom improvement for up to 15 months compared to 25% in the control group.79 In a review of 5 trials with 278 patients, hypnotherapy was associated higher levels of symptom improvement when compared to a control group or usual care. There were some biases in the studies, but hypnotherapy has been shown to be a beneficial for people with IBS.81
Hypnotherapy has also been studied for IBS in children.76 Fifty-two children with IBS or functional (unknown cause) abdominal pain were randomized to hypnotherapy or standard care . After 3 months of treatment, those in the hypnotherapy group reported less pain. A follow-up study found that these effects lasted for almost 5 years in about 2/3 of the children.77
Relaxation therapy may also be helpful.53,54,66 ,68 For example, in a randomized study involving 75 women with IBS, those who participated in mindfulness meditation therapy experienced more of an improvement in their symptoms compared to those who participated in a support group.71 A review of 6 trials with 255 patients found relaxation therapy had higher incidence of some improvement. In these trials, relaxation therapy was compared to a control group or usual care. Although the results were not conclusive, the review found relaxation therapy to be beneficial.81
Acupuncture has been proposed as a treatment for IBS. However, a number of studies, including 2 systematic reviews, have not found strong evidence to support the use of acupuncture for this condition.32,33,43,65,73,74 The most recent review included 17 trials involving 1,806 people that compared real acupuncture to a range of control groups, such as sham acupunture, psychotherapy and medication, among others.74 In the 5 trials that included real versus sham acupuncture, there were no significant differences between the two treatment groups on IBS symptoms. Other trials without a placebo control showed more of a positive effect, though. For example, people receiving acupuncture treatments reported more symptom relief compared to those receiving psychotherapy or medication .
A review of 11 low-quality randomized trials compared moxibustion or moxibustion with acupuncture to drug therapy. Moxibustion (the use of heat to stimulate acupuncture points) was associated with improved IBS symptoms when compared to drug therapy alone. However, the quality of the sutdies may have influenced the outcomes. Researchers in all acupuncture trials listed above highlighted the need for more studies.84
For a discussion of homeopathic approaches to irritable bowel syndrome, see the Homeopathy database.
References[ + ]
1. Guthrie E, Creed F, Dawson D, et al. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br J Psychiatry. 1993;163:315-321.
2. Palsson OS, Turner MJ, Johnson DA. Hypnotherapy for irritable bowel syndrome: symptom improvement and autonomic nervous system effects. Poster presented at: Digestive Disease Week 2000; May 21-24, 2000; San Diego, CA.
3. Harvey RF, Hinton RA, Gunary RM, et al. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet. 1989;1:424-425.
4. Waxman D. The irritable bowel: a pathological or psychological syndrome? J R Soc Med. 1988;81:718-720.
5. Guthrie E, Creed F, Dawson D, et al. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology. 1991;100:450-457.
6. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy. Aliment Pharmacol Ther. 1996;10:91-95.
7. Rees WD, Evans BK, Rhodes J. Treating irritable bowel syndrome with peppermint oil. Br Med J. 1979;2:835-836.
8. Dew MJ, Evans BK, Rhodes J. Peppermint oil for the irritable bowel syndrome: a multicentre trial. Br J Clin Pract. 1984;38:394,398.
9. Lawson MJ, Knight RE, Tran K, et al. Failure of enteric-coated peppermint oil in the irritable bowel syndrome: a randomized, double-blind crossover study. J Gastroenterol Hepatol. 1988;3:235-238.
10. Nash P, Gould SR, Barnardo DE. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract. 1986;40:292-293.
11. Liu JH, Chen GH, Yeh HZ, et al. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol. 1997;32:765-768.
12. Kline RM, Kline JJ, Di Palma J, et al. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138:125-128.
13. Kline RM, Kline JJ, Di Palma J, et al. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138:125-128.
15. Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1231-1238.
16. Halpern GM, Prindiville T, Blankenburg M, et al. Treatment of irritable bowel syndrome with lacteol fort: a randomized, double-blind, cross-over trial. Am J Gastroenterol. 1996;91:1579-1585.
17. Tarpila S, Kivinen A. Ground flaxseed is an effective hypolipidemic bulk laxative [abstract]. Gastroenterology. 1997;112:A836.
18. Smith MA, Youngs GR, Finn R. Food intolerance, atopy, and irritable bowel syndrome. Lancet. 1985;2:1064.
19. McKee AM, Prior A, Whorwell PJ. Exclusion diets in irritable bowel syndrome: are they worthwhile? J Clin Gastroenterol. 1987;9:526-528.
20. Jones VA, McLaughlan P, Shorthouse M, et al. Food intolerance: a major factor in the pathogenesis of irritable bowel syndrome. Lancet. 1982;2:1115-1117.
21. Parker TJ, Naylor SJ, Riordan AM, et al. Management of patients with food intolerance in irritable bowel syndrome: the development and use of an exclusion diet. J Hum Nutr Diet. 1995;8:159-166.
22. King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet. 1998;352:1187-1189.
23. Ballegaard M, Bjergstrom A, Brondum S, et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32:569-571.
24. Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892-1897.
25. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143-1147.
26. O’Sullivan MA, et al. Bacterial supplementaion in the irritable bowel syndrome. A randomized double-blind placebo-controlled crossover study. Digest Liver Dis. 2000;32:294-301.
27. Sen S, Mullan MM, Parker TJ, et al. Effect of Lactobacillus plantarum 299v on colonic fermentation and symptoms of irritable bowel syndrome. Dig Dis Sci. 2002;47:2615-2620.
28. Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895-904.
29. Bensoussan A, Talley NJ, Hing M, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA. 1998;280:1585-1589.
30. Suarez F, Levitt MD, Adshead J, et al. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999;44:1317-1321.
31. Whorwell PJ. Use of hypnotherapy in gastrointestinal disease. Br J Hosp Med. 1991;45:27-29.
32. Forbes A, Jackson S, Walter C, et al. Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. Gut. 2002;50:A83.
33. Fireman Z, Segal A, Kopelman Y, et al. Acupuncture treatment for irritable bowel syndrome. A double-blind controlled study. Digestion. 2001;64:100-103.
34. Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005;12:601-606.
35. Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687-696.
36. Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome-a double blind, placebo-controlled, randomized study. Clin Nutr. 2005 Jul 26. [Epub ahead of print]
37. Nickolay K. Double blind trial of metoclopramide and Iberogast® in functional gastroenterology. Gastro Entero Hepatologie. 1984;2:4.
38. Song GH, Leng PH, Gwee KA, et al. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised double blind placebo controlled study. Gut. 2005 May 24. [Epub ahead of print]
39. Lu WZ, Gwee KA, Moochhalla S, et al. Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2005;22:927-934.
40. Brinkhaus B, Hentschel C, Von Keudell C, et al. Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial. Scand J Gastroenterol. 2005;40:936-943.
41. Olesen M, Gudmand-Hoyer E. Related Articles, Links Efficacy, safety, and tolerability of fructooligosaccharides in the treatment of irritable bowel syndrome. Am J Clin Nutr. 2000;72:1570-1575.
42. Bittner AC, Croffut RM, Stranahan MC, et al. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. Clin Ther. 2005;27:755-761.
43. Schneider A, Enck P, Streitberger K, et al. Acupuncture treatment in irritable bowel syndrome. Gut. 2005 Sep 8. [Epub ahead of print]
44. Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional Chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101:1574-1580
45. Vejdani R, Shalmani HR, Mir-Fattahi M, et al. The efficacy of an herbal medicine, carmint, on the relief of abdominal pain and bloating in patients with irritable bowel syndrome: a pilot study. Dig Dis Sci. 2006 Jul 26. [Epub ahead of print]
46. Saha L, Malhotra S, Rana S, et al. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol. 2007;41:29-32.
47. Gawronska A, Dziechciarz P, Horvath A, et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25:177-184.
48. Drisko J, Bischoff B, Hall M, et al. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006;25:514-522.
49. Cappello G, Spezzaferro M, Grossi L, et al. Peppermint oil (Mintoil®) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007 Apr 7. [Epub ahead of print]
50. Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther. 2007;26:475-486.
51. O’Mahony L, J, Kelly P, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541-550.
52. Paineau D, Payen F, Panserieu S, et al. The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders. Br J Nutr. 2007 Aug 13. [Epub ahead of print]
53. Van der Veek PP, Van Rood YR, Masclee AA. Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:943-952.
54. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of IBS and stabilises intestinal microbiota. Aliment Pharmacol Ther. 2007 Oct 6. [Epub ahead of print]
55. Sinn DH, Song JH, Kim HJ, et al. Therapeutic effect of Lactobacillus acidophilus -SDC 2012, 2013 in patients with irritable bowel syndrome. Dig Dis Sci. 2008 Feb 15.
56. Wilhelm SM, Brubaker CM, Varcak EA, et al. Effectiveness of probiotics in the treatment of irritable bowel syndrome. Pharmacotherapy. 2008;28:496-505.
57. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol. 2008;32:147-152.
58. Nikfar S, Rahimi R, Rahimi F, et al. Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized, controlled trials. Dis Colon Rectum. 2008 May 9.
59. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2650-2661.
60. De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam. 2008;38:16-25.
61. Spiller P. Review article: probiotics and prebiotics in irritable bowel syndrome (IBS). Aliment Pharmacol Ther. 2008 Jun 4.
62. Williams E, Stimpson J, Wang D, et al. Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2008 Sep 10.
63. Agrawal A, Houghton LA, Morris J, 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. 2008 Sep 17.
64. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008 Nov 13;337:a2313.
65. Lembo AJ, Conboy L, Kelley JM, et al. A treatment trial of acupuncture in IBS patients. Am J Gastroenterol. 2009;104:1489-1497.
66. Lahmann C, Röhricht F, Sauer N. Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial. J Altern Complement Med. 2010;16(1):47.
67. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010;55(5):1385-1390.
68. Shinozaki M, Kanazawa M, Kano M, Endo Y, Nakaya N, Hongo M, Fukudo S. Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial. Appl Psychophysiol Biofeedback. 2010;35(3):189-198.
69. Guandalini S, Magazzù G, Chiaro A, et al. VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study. J Pediatr Gastroenterol Nutr. 2010;51(1):24-30.
70. Choi CH, Jo SY, Park HJ, Chang SK, Byeon JS, Myung SJ. A randomized, double-blind, placebo-controlled multicenter trial of saccharomyces boulardii in irritable bowel syndrome: effect on quality of life. J Clin Gastroenterol. 2011;45(8):679-683.
71. Gaylord SA, Palsson OS, Garland EL, et al. Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. Am J Gastroenterol. 2011;106(9):1678-1688.
72. Horvath A, Dziechciarz P, Szajewska H. Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood. Aliment Pharmacol Ther. 2011;33(12):1302-1310.
73. Lim B, Manheimer E, Lao L, et al. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.
74. Manheimer E, Wieland LS, Cheng K, Li SM, Shen X, Berman BM, Lao L. Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2012 Apr 10.
75. Lindfors P, Unge P, Arvidsson P, et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107(2):276-285.
76. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133(5):1430-1436.
77. Vlieger AM, Rutten JM, Govers AM, Frankenhuis C, Benninga MA. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012;107(4):627-631.
78. Guglielmetti S, Mora D, Gschwender M, Popp K. Randomised clinical trial: Bifidobacterium bifidum MIMBb75 significantly alleviates irritable bowel syndrome and improves quality of life--a double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2011;33(10):1123-1132.
79. Moser G, Trägner S, Gajowniczek EE. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108(4):602-609.
80. Li Q, Liu F, et al. Treatment of constipation-predominant irritable bowel syndrome by focusing on the liver in terms of Traditional Chinese Medicine: a meta-analysis. J Tradit Chin Med. 2013;33(5):561-571.
81. Ford AC, Quigley EM, et al. Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: Systematic review and meta-analysis. Am J Gastroenterol. [Epub ahead of print 2014 Mar].
82. Ford AC, Quigley EM, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-1561.
83. Stevenson C, Blaauw R, et al. Randomized clinical trial: Effect of Lactobacillus plantarum 299v on symptoms of irritable bowel syndrome. Nutrition. 2014;30(10):1151-1157.
84. Park JW, Lee BH, et al. Moxibustion in the management of irritable bowel syndrome: Systematic review and meta-analysis. BMC Complement Altern Med. 2013;13:247.
85. Bensoussan A, Kellow JE, Bourchier SJ, et al. Efficacy of Chinese herbal medicine in providing adequate relief of constipation-predominant irritable bowel syndrome: a randomized controlled trial. Clin Gastroenterol Hepatol. 2015;13(11):1946-1954.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 7/6/2016
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