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BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2013

Open Access 01-12-2013 | Research article

Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis

Authors: Jae-Woo Park, Byung-Hee Lee, Hyangsook Lee

Published in: BMC Complementary Medicine and Therapies | Issue 1/2013

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Abstract

Background

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Many patients suffer from IBS that can be difficult to treat, thus complementary therapies which may be effective and have a lower likelihood of adverse effects are being sought.
This systematic review and meta-analysis aimed at critically evaluating the current evidence on moxibustion for improving global symptoms of IBS.

Methods

We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, CINAHL, and CNKI databases for randomised controlled trials (RCTs) of moxibustion comparing with sham moxibustion, pharmacological medications, and other active treatments in patients with IBS. Trials should report global symptom improvement as an outcome measure. Risk of bias for each RCT was assessed according to criteria by the Cochrane Collaboration, and the dichotomous data were pooled according to the control intervention to obtain a risk ratio (RR) of global symptom improvement after moxibustion, with 95% confidence intervals (CI).

Results

A total of 20 RCTs were eligible for inclusion (n = 1625). The risk of bias was generally high. Compared with pharmacological medications, moxibustion significantly alleviated overall IBS symptoms but there was a moderate inconsistency among studies (7 RCTs, RR 1.33, 95% CI [1.15, 1.55], I2 = 46%). Moxibustion combined with acupuncture was more effective than pharmacological therapy but a moderate inconsistency among studies was found (4 RCTs, RR 1.24, 95% CI [1.09, 1.41], I2 = 36%). When moxibustion was added to pharmacological medications or herbal medicine, no additive benefit of moxibustion was shown compared with pharmacological medications or herbal medicine alone. One small sham-controlled trial found no difference between moxibustion and sham control in symptom severity (mean difference 0.35, 95% CI [−0.77, 1.47]). Moxibustion appears to be associated with few adverse events but the evidence is limited due to poor reporting.

Conclusions

This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice.
Appendix
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Literature
1.
Ford A, Vandvik P: Irritable bowel syndrome. Clin Evid. 2010, 1: 410-
2.
Brandt L, Chey W, Foxx-Orenstein A, Schiller L, Schoenfeld P, Spiegel B, Talley N, Quigley E, American College of Gastroenterology Task Force on Irritable Bowel Syndrome: An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009, 104: S1-S35.CrossRefPubMed
3.
Ford A, Talley N: IBS in 2010: advances in pathophysiology, diagnosis and treatment. Nat Rev Gastroenterol Hepatol. 2011, 8: 76-78. 10.1038/nrgastro.2010.216.CrossRefPubMed
4.
Magge S, Lembo A: Complementary and alternative medicine for the irritable bowel syndrome. Gastroenterol Clin North Am. 2011, 40: 245-253. 10.1016/j.gtc.2010.12.005.CrossRefPubMed
5.
Barnes P, Bloom B, Nahin R: Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports; no 12. 2008, Hyattsville, MD: National Center for Health Statistics
6.
Ouyang H, Chen JDZ: Review article: therapeutic roles of acupuncture in functional gastrointestinal disorders. Aliment Pharmacol Ther. 2004, 20: 831-841. 10.1111/j.1365-2036.2004.02196.x.CrossRefPubMed
7.
World Health Organization Western Pacific Region: WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. 2007, World Health Organization Western Pacific: Manila, Philippines
8.
9.
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, 107: 835-847. 10.1038/ajg.2012.66. quiz 848CrossRefPubMedPubMedCentral
10.
Manheimer E, Cheng K, Wieland LS, Min LS, Shen X, Berman BM, Lao L: Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2012, 5: CD005111
11.
Higgins J, Altman D: Chapter 8: assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions. Edited by: Higgins J, Green S. 2008, Chichester: The Cochrane Collaboration and John Wiley & Sons Ltd, 187-241.CrossRef
12.
Deeks J, Higgins J, Altman D: Chapter 9: analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions. Edited by: Higgins J, Green S. 2008, Chichester: The Cochrane Collaboration and John Wiley & Sons Ltd, 243-296.CrossRef
13.
Higgins JP, Thompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med. 2002, 21 (11): 1539-1558. 10.1002/sim.1186.CrossRefPubMed
14.
Carroll D, Tramèr M, McQuay H, Nye B, Moore A: Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain. Br J Anaesth. 1996, 77: 798-803. 10.1093/bja/77.6.798.CrossRefPubMed
15.
Pildal J, Hróbjartsson A, Jørgensen K, Hilden J, Altman D, Gøtzsche P: Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. Int J Epidemiol. 2007, 36 (4): 847-857. 10.1093/ije/dym087.CrossRefPubMed
16.
Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JW: Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2011, 8: CD003460
17.
An G, Li N, Zhai G, Liu H, Sun J, Liang H, Xu R: Evaluation of the therapeutic effect of acupuncture and moxibustion on irritable bowel syndrome [in Chinese]. Shanghai J Acupunct Moxibustion. 2010, 29 (6): 354-356.
18.
Anastasi JK, McMahon DJ, Kim GH: Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion. Gastroenterol Nurs. 2009, 32 (4): 243-255. 10.1097/SGA.0b013e3181b2c920.CrossRefPubMed
19.
Chen Q: Clinical study on irritable bowel syndrome of diarrhea type with Chang-three-needle technique [in Chinese]. 2011, Guangzhou university of Chinese medicine, Guangzhou
20.
Chu H, Huang X, Li X, Cheng H, Ding Y: Moxibustion for diarrhea-type irritable bowel syndrome: a clinical study [in Chinese]. J Anhui Trad Chin Med Coll. 2011, 30 (6): 33-36.
21.
Hu D, Kang M, Xiong J, Deng P: Irritable bowel syndrome with diarrhea (IBS-D) treated with moxibustion on heat-sensitive acupoints: a randomized controlled trial. World J Acupunct-Moxibustion. 2012, 22 (2): 1-5. 10.1016/S1003-5257(12)60019-1.CrossRef
22.
Huang Z, Jin H: A study on the improved therapeutic effect of colon hydrotherapy combined with moxibustion on irritable bowel syndrome [in Chinese]. Chin J Integr Trad West Med Dig. 2007, 15 (5): 330-331.
23.
Jiang J, Zhao N, Xu J, Wang H: The efficacy observation of trimebutine with ginger partitioned moxibustion for diarrhea-predominant irritable bowel syndrome (IBS-D) [in Chinese]. Shenzhen J Integr Trad Chin West Med. 2010, 20 (4): 239-241.
24.
Liu G: Observation of treatment effect of acupuncture and moxibustion plus psychotherapy for irritable bowel syndrome [in Chinese]. Zhongguo Zhenjiu. 1997, 17 (10): 611-612.
25.
Luo S, Chen C: Clinical observation of therapeutic effect of thunderbolt moxibustion on constipation-predominant irritable bowel syndrome (IBS-C) [in Chinese]. Guangxi J Trad Chin Med. 2011, 34 (5): 268-269.
26.
Luo S, Chen C: Shuxiangjiu (sparse incense moxibustion) for treatment of constipation-predominant irritable bowel syndrome (IBS-C) of stagnation of liver-qi stagnation type patient’s curative effect observation [in Chinese]. Guiding J Trad Chin Med Pharmacy. 2012, 18 (1): 51-52.
27.
Luo S, Long J, Huang L: The curative effect observation and nursing of moxibustion combined with pinaverium bromide tablets to cure abdominal pain and diarrhea intestine irritable syndrome [in Chinese]. J Jinggangshan Med Coll. 2008, 15 (4): 39-40.
28.
Ni Y, Lu J: Clinical research on moxibustion treatment of diarrhea type irritable bowel syndrome [in Chinese]. World J Acupunct-Moxibustion. 2001, 11 (3): 19-23.
29.
Shang Z, Xu M, Tian L: Acupuncture combined with moxibustion in the treatment of 48 patients with diarrhea-predominant irritable bowel syndrome [in Chinese]. China Med Herald. 2012, 9 (3): 96-97.
30.
Wang J, He D, Kuang Y: Combination of Chinese herbal medicine and moxibustion treatment in 30 cases of diarrhea-predominant irritable bowel syndrome (IBS-D) [in Chinese]. J New Chin Med. 2009, 41 (3): 82-
31.
Wang W: Clinical observation of warm needling treatment for diarrhea-predominant irritable bowel syndrome (IBS-D) [in Chinese]. J Emerg Trad Chin Med. 2008, 17 (10): 1377-1407.
32.
Wu H, Wang J, Chen H, Hua X, Shi Z: The therapeutic effect and immunological mechanism of herbs-partition moxibustion in treating irritable bowel syndrome. Zhongguo Zhenjiu. 1996, 16 (2): 43-45.
33.
Xiong X, Lin Y: Acupuncture plus traditional Chinese herbal medicine in treating 42 patients with diarrhea-predominant irritable bowel syndrome (IBS-D) [in Chinese]. J Fujian Univ Trad Chin Med. 2008, 18 (2): 38-40.
34.
Xue Y, Tian X: A clinical research of the effect of acupuncture and its relationship between free radicals and irritable bowel syndrome [in Chinese]. Chin Arch Trad Chin Med. 2009, 27 (1): 111-112.
35.
Zeng Y, Bao Y, Chu J, Li H, Zhu G, Zhang W: Effect of moxibustion on diarrhea-dominant irritable bowel syndrome (IBS-D) patients in dog days [in Chinese]. Chin Arch Trad Chin Med. 2010, 28 (8): 1774-1776.
36.
Zhang Y, Yan C, Xie S: Ginger-partitioned moxibustion at CV8 treatment for 30 cases of diarrhea-predominant irritable bowel syndrome (IBS-D) [in Chinese]. Jiangxi J Trad Chin Med. 2007, 8: 69-70.
37.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche P, Ioannidis J, Clarke M, Devereaux P, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009, 339: b2700-10.1136/bmj.b2700.CrossRefPubMedPubMedCentral
38.
MacPherson H, Altman DG, Hammerschlag R, Li Y, Wu T, White A, Moher D, On behalf of the STRICTA revision group: Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010, 7: e1000261-10.1371/journal.pmed.1000261.CrossRefPubMedPubMedCentral
39.
Irvine E, Whitehead W, Chey W, Matsueda K, Shaw M, Talley N, Veldhuyzen van Zanten S, Design of Treatment Trials Committee: Design of treatment trials for functional gastrointestinal disorders. Gastroenterology. 2006, 130 (5): 1538-1551. 10.1053/j.gastro.2005.11.058.CrossRefPubMed
40.
Odgaard-Jensen J, Vist G, Timmer A, Kunz R, Akl E, Schünemann H, Briel M, Nordmann A, Pregno S, Oxman A: Randomisation to protect against selection bias in healthcare trials. Cochrane Database Syst Rev. 2011, 4: MR000012
41.
Sedgwick P: Allocation concealment. BMJ. 2012, 344 (e156): doi:10.1136/bmj.e156
42.
Spiller R: Problems and challenges in the design of irritable bowel syndrome clinical trials: experience form published trials. Am J Med. 1999, 107 (5A): 91S-97S.CrossRefPubMed
43.
Zhao B, Wang X, Lin Z, Liu R, Lao L: A novel sham moxibustion device: a randomized, placebo-controlled trial. Complement Ther Med. 2006, 14 (1): 53-60. 10.1016/j.ctim.2005.06.003.CrossRefPubMed
44.
Pham B, Klassen T, Lawson M, Moher D: Language of publication restrictions in systematic reviews gave different results depending on whether the intervention was conventional or complementary. J Clin Epidemiol. 2005, 58 (8): 769-776. 10.1016/j.jclinepi.2004.08.021.CrossRefPubMed
45.
Vickers A, Goyal N, Harland R, Rees R: Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials. 1998, 19 (2): 159-166. 10.1016/S0197-2456(97)00150-5.CrossRefPubMed
46.
Tang J, Zhan S, Ernst E: Review of randomised controlled trials of traditional Chinese medicine. BMJ. 1999, 319 (7203): 160-161. 10.1136/bmj.319.7203.160.CrossRefPubMedPubMedCentral
47.
Egger M, Jüni P, Bartlett C, Holenstein F, Sterne J: How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. 2003, 7: 1-76.PubMed
48.
Thompson SG: Systematic Review: Why sources of heterogeneity in meta-analysis should be investigated. BMJ. 1994, 309 (6965): 1351-1355. 10.1136/bmj.309.6965.1351.CrossRefPubMedPubMedCentral
49.
50.
Dixon-Woods M, Critchley S: Medical and lay views of irritable bowel syndrome. Fam Pract. 2000, 17 (2): 108-113. 10.1093/fampra/17.2.108.CrossRefPubMed
51.
Ford A, Brandt L, Young C, Chey W, Foxx-Orenstein A, Moayyedi P: Efficacy of 5-HT3 antagonists and 5-HT4 agonists in irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2009, 104: 1831-1843. 10.1038/ajg.2009.223.CrossRefPubMed
52.
MacPherson H, Tilbrook H, Bland M, Bloor K, Brabyn S, Cox H, Kang'ombe A, Man M, Stuardi T, Torgerson D: Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterol. 2012, 12 (1): 150-10.1186/1471-230X-12-150.CrossRefPubMedPubMedCentral
53.
Park JE, Lee SS, Lee MS, Choi SM, Ernst E: Adverse events of moxibustion: a systematic review. Complement Ther Med. 2010, 18 (5): 215-223. 10.1016/j.ctim.2010.07.001.CrossRefPubMed
54.
Koo S, Kim S, Park H, Shin S, Lee S, Jang I, Chae H, Chae Y: A guide to safe acupuncture and moxibustion practice. 2011, Seoul: Koonja publishing
55.
Kim SY, Lee H, Chae Y, Park HJ, Lee H: A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupunct Med. 2012, doi:10.1136/acupmed-2012-010178
56.
van den Berg I, Kaandorp GC, Bosch JL, Duvekot JJ, Arends LR, Hunink MGM: Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach. Complement Ther Med. 2010, 18 (2): 67-77. 10.1016/j.ctim.2010.01.003.CrossRefPubMed
57.
Stamuli E, Bloor K, MacPherson H, Tilbrook H, Stuardi T, Brabyn S, Torgerson D: Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a pragmatic randomised controlled trial in primary care. BMC Gastroenterol. 2012, 12 (1): 149-10.1186/1471-230X-12-149.CrossRefPubMedPubMedCentral
Metadata
Title
Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis
Authors
Jae-Woo Park
Byung-Hee Lee
Hyangsook Lee
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2013
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/1472-6882-13-247

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