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Original Article | Open Access

Adding Chinese herbal medicine to probiotics for irritable bowel syndrome-diarrhea: A systematic review and meta-analysis of randomized controlled trials

Fanlong Bua, Weiguang Wanga, Ruilin Chenb, Ziyi Linc, Mei Hana, Nicola Robinsona,d, Xuehan Liua, Chunli Lua, Jianping Liua( )
Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
Beijing Hospital of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
School of Health and Social Care, London South Bank University, London, SE1 0AA, UK

Peer review under responsibility of Beijing University of Chinese Medicine.

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Abstract

Objective

This study assessed whether Chinese herbal medicine (CHM) combined with probiotics/synbiotics for irritable bowel syndrome - diarrhea (IBS-D) was more effective and safer than probiotics/synbiotics alone.

Methods

Ten databases were searched for randomized control trials (RCTs) of IBS-D as diagnosed by Manning or Rome criteria. Trials comparing probiotics and probiotics with CHM were included. The Cochrane risk of bias (ROB) was evaluated for each trial. RevMan 5.3 was used to conduct a meta-analysis.

Results

Twenty-six RCTs were included (25 Chinese, 1 English), involving 2045 participants. Meta-analysis was conducted on two outcomes: overall symptom improvement and relapse. CHM combined with live Bifidobacterium and Lactobacillus preparations reduced relapse rate (RR 0.28, 95%CI 0.15–0.52, 3 trials, n = 205) compared with probiotics alone. The subgroup analysis showed the benefit of CHM prescriptions based on soothing liver and invigorating spleen (1.28, 1.14–1.44, 3,244), invigorating spleen and resolving dampness (1.20, 1.03–1.41, 2,128), or warming and invigorating spleen and kidney formulae (1.27, 1.09–1.46, 2,210) combined with triple Bifidobacterium preparations than the same probiotics alone which improved overall symptoms for IBS-D. There was unclear bias in almost domains of ROB. Most studies had a high risk of bias due to lack of blinding of investigator and participants, and selective reporting.

Conclusions

This study showed that CHM combined with probiotics may reduce relapse rate by 72%, and improve overall symptoms of IBS-D (as diagnosed by Rome Ⅱ and Ⅲ) compared to probiotics alone. From the limited subgroup analysis, only soothing liver and invigorating spleen formulae, represented by Tongxie Yaofang, added to triple Bifidobacterium preparations may be superior to the single preparations in terms of overall symptoms. However, due to the poor methodological quality and small sample size of the trials, these findings must be interpreted with caution.

Keywords

Meta-analysisSystematic reviewRandomized controlled trialsProbioticChinese herbal medicineSynbioticIrritable bowel syndrome

References

1

Lacy BE, Mearin F, Chang L, et al. Bowel disorders. Gastroenterology. 2016;150: 1393-1407.
Crossref Google Scholar
2

Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7): 712-721.
Crossref Google Scholar
3

Inadomi JM, Fennerty MB, Bjorkman D. Systematic review: the economic impact of irritable bowel syndrome. Aliment Pharmacol Ther. 2003;18(7): 671-682.
Crossref Google Scholar
4

Spiller R, Aziz Q, Creed F, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut. 2007;56(12): 1770-1798.
Crossref Google Scholar
5

Grundmann O, Yoon SL. Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners. J Gastroenterol Hepatol. 2010;25(4): 691-699.
Crossref Google Scholar
6

Ng QX, Soh A, Loke W, et al. A meta-analysis of the clinical use of curcumin for irritable bowel syndrome (IBS). J Clin Med. 2018;7(10): 298.
Crossref Google Scholar
7

Flik CE, Bakker L, Laan W, et al. Systematic review: the placebo effect of psychological interventions in the treatment of irritable bowel syndrome. World J Gastroenterol. 2017;23(12): 2223-2233.
Crossref Google Scholar
8

Ford AC, Moayyedi P, Chey WD, et al. American college of gastroenterology monograph on management of irritable bowel syndrome. Am J Gastroenterol. 2018;113(suppl 2): 1-18.
Crossref Google Scholar
9

Moayyedi P, Andrews CN, MacQueen G, et al. Canadian association of gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). J Can Assoc Gastroenterol. 2019;2(1): 6-29.
Crossref Google Scholar
10

Gastrointestinal Functional Diseases Collaborative Group of Chinese Society of Gastroenterology, Gastrointestinal Dynamics Group. Chinese expert consensus on irritable bowel syndrome (2015, Shanghai). Chin J Dig. 2016;36(5): 299-312 [Chinese].
Google Scholar
11

Rijkers GT, Bengmark S, Enck P, et al. Guidance for substantiating the evidence for beneficial effects of probiotics: current status and recommendations for future research. J Nutr. 2010;140(3): 671S-676S.
Crossref Google Scholar
12

Pandey KR, Naik SR, Vakil BV. Probiotics, prebiotics and synbiotics‒a review. J Food Sci Technol. 2015;52(12): 7577-7587.
Crossref Google Scholar
13

Moraes-Filho JP, Quigley EM. The intestinal microbiota and the role of probiotics in irritable bowel syndrome: a review. Arq Gastroenterol. 2015;52(4): 331-338.
Crossref Google Scholar
14

Zhang Y, Li L, Guo C, et al. Effects of probiotic type, dose and treatment duration on irritable bowel syndrome diagnosed by Rome Ⅲ criteria: a meta-analysis. BMC Gastroenterol. 2016;16(1): 62.
Crossref Google Scholar
15

Didari T, Mozaffari S, Nikfar S, et al. Effectiveness of probiotics in irritable bowel syndrome: updated systematic review with meta-analysis. World J Gastroenterol. 2015;21(10): 3072-3084.
Crossref Google Scholar
16

Moayyedi P, Ford AC, Talley NJ, et al. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59(3): 325-332.
Crossref Google Scholar
17

Zheng XY. Guiding Principles for Clinical Research of New Drugs in Traditional Chinese Medicine. Beijing, China: China Medical Science Press; 2002.
18

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11): 1539-1558.
Crossref Google Scholar
19
Chen YY. Clinical Study of Dingtong Zhixie Tang Combination with Efficacy ofProbiotics in the Treatment of Diarrhea - a Predominant Irritable Bowel Syndrome(Liver Depression and Spleen Deficiency Syndrome) [dissertation]. Chengdu: Chengdu University of TCM; 2015.
20

Ko SJ, Han G, Kim SK, et al. Effect of Korean herbal medicine combined with a probiotic mixture on diarrhea-dominant irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Evid-Based Compl Alt. 2013: 1-10 2013.
Crossref Google Scholar
21

Shu J, Dong J, Ma D. Clinical observation and mechanism investigation of Changfuan decoction on irritable bowel syndrome with diarrhea (D-IBS). J Emerg Tradit Chin Med. 2018;27(2): 320-323 [Chinese].
Google Scholar
22

Sun ZS, Sun DD. A clinic study of treatment on diarrhea-predominant irritable bowel syndrome by using integrated traditional Chinese medicine and western medicine therapy. China Mod Med. 2016;23(34): 136-138 [Chinese].
Google Scholar
23

Tang SW, Cheng M, Wu ZP, et al. Efficacy of integrated traditional Chinese medicine with western in patients with diarrhea-predominant irritable bowel syndrome and its relation to serum inflammatory cytokines. Chin J Gen Pract. 2017;16(7): 522-526 [Chinese].
Google Scholar
24

Zhu CJ. Influence and efficacy of Bifid Triple Viable capsules combined with Shenling Baizhu powder on plasma somatostatin and neuropeptide Y levels of patients with diarrhea - irritable Bowel Syndrome. Chin J Microecol. 2015;27(5): 552-554 [Chinese].
Google Scholar
25

Zhu YJ. Experience of Guizhi Shaoyao decoction in treating diarrhea-type irritable bowel syndrome. Mod J Integr Tradit Chin West Med. 2012;21(5): 532 [Chinese].
Google Scholar
26

Cao JS. Therapeutic effect of self-made Wenshen Jianpi decoction on diarrhea-predominant irritable bowel syndrome. 01. Guangxi J TCM. 2017;40: 36-38 [Chinese].
Google Scholar
27

Chen CY, Zheng YZ, Zhu DY. Treatment of 44 cases of diarrhea irritable bowel syndrome with Jianpi Bushen recipe and PeiFeiKang. World Chin Med. 2008(3): 163 [Chinese].
Google Scholar
28

Huang CF, Jin H, Di QZ. Treatment of 64 cases of diarrhea-predominant irritable bowel syndrome with PeiFeiKang combined with Zhenqi Fuzheng granule. China Pharm. 2011;20(24): 75-76 [Chinese].
Crossref Google Scholar
29

Lai Y, Xu SY. Evaluation of clinical effects of modified Tongxie Yaofang decoction in treatment of irritable bowel syndrome based on brain-intestinal axis theory. World Chin J Dig. 2016;24(31): 4288-4292 [Chinese].
Crossref Google Scholar
30

Li JH, Cai BY. Therapeutic effect of Bupi Yichang bolus combined with PeiFeiKang on diarrhea-predominant irritable bowel syndrome. J New Chin Med. 2012;44(7): 38-40 [Chinese].
Google Scholar
31

Zhang X. Effect of integrated traditional Chinese and western medicine on plasma somatostatin and neuropeptide Y levels in patients with diarrhea-predominant irritable bowel syndrome. Yunnan J TCM Mater Medica. 2017;38(3): 44-45 [Chinese].
Crossref Google Scholar
32

Zheng C, Xu D. Treatment of 86 cases of diarrhea-type irritable bowel syndrome with Chinese and western medicine. J North Pharm. 2012;9(9): 16 [Chinese].
Google Scholar
33
Zheng LS, Cheng ZQ. Clinical observation on treatment of diarrhea-type irritable bowel syndrome with combination of traditional Chinese medicine andwestern medicine. In: Paper Presented at: The 20th National Symposium onSpleen and Stomach Diseases of the Chinese Academy of Traditional ChineseMedicine Spleen and Stomach Branch. 2018 [Lanzhou, China].
34

Zheng XL, Nie SY, Ma YY, et al. Investigation of Yiji capsule on patients with diarrhea-predominant irritable bowel syndrome and change of interleukin-1β and interleukin - 13. Hebei J TCM. 2013;35(3): 342-344 [Chinese].
Google Scholar
35

Zhou SF, Xu SY, Yang JL, et al. Clinical efficacy of Shenling Guchang granule combined with JinShuangQi in the treatment of diarrhea predominant irritable bowel syndrome with deficiency of the spleen and stomach. Chin J Microecol. 2016;28(7): 795-798 [Chinese].
Google Scholar
36

Zhou Y. Buzhong Yiqi pill combined with Bifid Triple live bacteria tablets in the treatment of women with diarrhea type irritable bowel syndrome. J Taishan Med Coll. 2016;37(7): 781-782 [Chinese].
Google Scholar
37

Quan LZ, Luo Q. Therapeutic effect of modified Tongxie Yaofang combined with JinShuangQi on diarrhea-predominant irritable bowel syndrome. J Emerg TCM. 2009;18(6): 889-906 [Chinese].
Google Scholar
38

Deng C, Deng JM. Clinical observations of the treatment of diarrhea-irritable bowel syndrome by the combination of traditional Chinese medicine Gexia Zhuyu Tang and western medicine Miya. Guangming J Chin Med. 2005(5): 50-51 [Chinese].
Google Scholar
39

Luo CM, Ou ZS, Ji AD. Clinical observation on treatment of diarrhea irritable bowel syndrome with Tongxie Yaofang and PeiFeiKang. Fujian J TCM. 2007(2): 16-18 [Chinese].
Google Scholar
40

Meng L, Guo XC. Treatment of 45 cases of diarrhea irritable bowel syndrome with Fuzi Lizhong pill combined with probiotics. Mod TCM. 2019;39(1): 70-72.
Google Scholar
41

Wang RR, Zhang HT, Liu KY. Therapeutic effect of integrated traditional Chinese and western medicine on diarrhea-predominant irritable bowel syndrome. J Binzhou Med Univ. 2006(4): 309 [Chinese].
Google Scholar
42

Wu Y. Therapeutic effect of modified Tongxie Yaofang combined with PeiFeiKang on diarrhea-predominant irritable bowel syndrome. Mod J Integr Tradit Chin West Med. 2016;25(11): 1198-2000 [Chinese].
Google Scholar
43
Xu RL. Effect And Mechanism of Modified Shenling Baizhu Powder in Treatment ofSpleen Deficiency and Dampness Type IBS [dissertation]. Nanjing: Nanjing University of Chinese Medicine; 2013.
44

Yao M, Chen YP, Xu G. Sixty-four children' s diarrheas irritable bowel syndrome treated with integrated traditional Chinese and western medicine. Mod J Integr Tradit Chin West Med. 2002(15): 1421-1422 [Chinese].
Google Scholar
45

Drossman DA, Hasler WL. Rome Ⅳ-functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6): 1257-1261.
Crossref Google Scholar
46

McKenzie YA, Thompson J, Gulia P, et al. British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5): 576-592.
Crossref Google Scholar
47

Rej A, Avery A, Ford AC, et al. Clinical application of dietary therapies in irritable bowel syndrome. J Gastrointestin Liver Dis. 2018;27(3): 307-316.
Crossref Google Scholar
Journal of Traditional Chinese Medical Sciences
Volume 7 Issue 1,
March 2020
Pages 20-36
DOI: 10.1016/j.jtcms.2020.01.004
Cite this article:
Bu F, Wang W, Chen R, et al. Adding Chinese herbal medicine to probiotics for irritable bowel syndrome-diarrhea: A systematic review and meta-analysis of randomized controlled trials. Journal of Traditional Chinese Medical Sciences, 2020, 7(1): 20-36. https://doi.org/10.1016/j.jtcms.2020.01.004

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Received: 29 October 2019
Revised: 03 January 2020
Accepted: 03 January 2020
Published: 24 January 2020
© 2020 Beijing University of Chinese Medicine.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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