Irritable bowel syndrome (IBS) is a common, well-known condition. The efficacy of osteopathic therapy for patients with IBS, on the other hand, is not well documented. Researchers in the Netherlands conducted a randomized controlled trial to evaluate the effects of osteopathic manual therapy in patients with moderate IBS.
Thirty-nine adults (mean age 43.8 y) diagnosed as having IBS were randomly assigned to receive either osteopathic manual therapy (n=20) or standard care (n=19). Standard care consisted of advice and dietary recommendations. Laxatives, loperamide hydrochloride, and mebeverine hydrochloride were prescribed on an as-needed basis for constipation, diarrhea, and cramps, respectively. Separate osteopathic manual therapy sessions were provided five times, 2 to 3 weeks apart, and were individualized for each patient according to the osteopath's findings at each visit. All subjects recorded the severity of IBS, symptoms, quality of life, and adverse effects according to standardized tools (eg, a validated IBS quality of life questionnaire) at baseline and at 1-, 3-, and 6-month follow-up.
Three patients (1 in the osteopathic manual therapy group and 2 receiving standard care) were excluded from data analysis because of protocol violations. Osteopathic manual therapy was superior to standard treatment (P<.006) in overall symptom improvement. In the osteopathic manual therapy group, 13 subjects (68%) reported definite improvement, 5 (27%) had slight improvement, and 1 (5%) reported complete resolution of symptoms. Although subjects receiving osteopathic manual therapy reported a slight transient increase in symptom severity after the first treatment session, no worsening of symptoms was noted in these subjects at 6 months. By comparison, 3 subjects (18%) in the standard care cohort had definite improvement and 10 (59%) reported slight improvement, but 3 (17%) had worsening of symptoms at the 6-month follow-up visit. In addition, the improvement in quality of life was statistically significant (P<.009) in the therapy group, as was the decrease in symptom severity compared with the standard care cohort (P=.02).
Although this study had few subjects, it is a well-designed randomized clinical trial in which the results favored osteopathic manual therapy over standard care. Follow-up studies with a larger patient population, additional osteopaths, or US-trained osteopathic physicians providing osteopathic manipulative treatment are warranted. A sham intervention should be developed and used before definitive conclusions can be drawn. The path is ours to follow. —M.A.S.
Hundscheid HWC et al. J Gastroenterol Hepatol. 2007;22:1394-1398.