Abstract
Context: Irritable bowel syndrome (IBS) is a common and often lifelong functional gastrointestinal disorder. There is a scarcity of effective management options for IBS.
Objective: To assess the effectiveness of osteopathic manipulative therapy (OMTh) for managing the symptoms of IBS.
Data Sources: Articles without language or publication-date restriction were searched in PubMed, Embase, Cochrane Library, PEDro, OSTMED.DR, and Osteopathic Research Web. Search terms included irritable bowel syndrome, IBS, functional colonic disease, colon irritable, osteopath*, osteopathic manipulation, osteopathic medicine, clinical trial, and randomized clinical trial. Experts in the field of visceral osteopathy were also contacted to identify additional studies.
Study Selection: The authors evaluated randomized controlled trials (RCTs) of OMTh for IBS in adults in whom IBS was diagnosed using Rome (I-III) criteria. If OMTh was not the sole intervention in the intervention group and if the same additional interventions were not applied to the control group, the study was excluded.
Data Extraction: Citation identification, study selection, and data extraction were independently undertaken by 2 reviewers with a data extraction form from the Cochrane Collaboration. A consensus method was used to resolve disagreements concerning the assessment of the methodologic quality of the RCTs that were reviewed.
Results: The search identified 10 studies that examined OMTh for patients with IBS; 5 studies (204 patients) met the inclusion criteria. All studies were assessed as having low risk of bias according to the Cochrane Collaboration criteria, although there was heterogeneity in the outcome measures and control interventions. Three studies used visual analog scales for abdominal pain, whereas others used the IBS severity score and the Functional Bowel Disorder Severity Index. A variety of secondary outcomes were used. All studies reported more pronounced short-term improvements with OMTh compared with sham therapy or standard care only. These differences remained statistically significant after variable lengths of follow-up in 3 studies.
Conclusion: The present systematic review provides preliminary evidence that OMTh may be beneficial in the treatment of patients with IBS. However, caution is required in the interpretation of these findings because of the limited number of studies available and the small sample sizes.
Irritable bowel syndrome (IBS) is a chronic, recurring gastrointestinal illness that varies in symptoms and characteristics.
1,2 Approximately 10% of the population has IBS at any given time—about 200 people per 100,000 receive an initial diagnosis of IBS each year.
2 The prevalence of IBS in North America ranges from 3% to 20%, with most prevalence estimates ranging from 10% to 15%.
3 It is more commonly diagnosed in people aged 50 years or older, and it occurs more frequently in women, at a women-to-men ratio of 2:1 to 4:1.
4,5
Symptoms of IBS are abdominal pain and discomfort associated with changes in bowel habits, such as increased frequency of stool, abnormal stool form, straining during defecation, defecation urgency, feeling of incomplete defecation, passage of mucus, and bloating.
6 The disease is diagnosed using the Rome Criteria (I-III), a globally recognized classification system.
7 Individuals with IBS tend to have substantial functional impairments, higher levels of disability,
4,8 and limitations in quality of life.
5 Interaction between motor and sensory dysfunctions seems to cause the symptoms of IBS, but this theory has yet to be definitively confirmed. Factors that affect luminal function—such as food, intestinal expansion, inflammation, bacteria, and provocative environmental influences (psychosocial stress)—seem to affect the gastrointestinal motility and visceral sensitivity in persons with IBS.
9 This gastrointestinal sensorimotor dysfunction can cause a deregulation in the brain-gut axis, which is the neural processing region between the intestines and brain.
10
The frequency and intensity of symptoms determine the level of medical treatment for patients with IBS, which can range from no or very little treatment to emergency treatment. Conventional therapies for patients with IBS generally involve the motor, sensory, or central gastrointestinal nervous system and include lactose reduction, fiber supplementation, bulking agents, laxatives, antispasmodics, antibiotics, psychological interventions, or antidepressants.
11-13 Whereas antispasmodics,
14,15 psychological interventions,
16 and antidepressants
17 have shown some benefits in the management of IBS, fiber supplementation,
18 stimulating laxatives,
19 and bulking agents
20 have shown little therapeutic value in randomized controlled trials (RCTs),
21 despite being used often for disease management.
22 Further, the efficacy of these therapies varies from study to study,
23,24 and a review in 2005 by Quartero et al
25 suggested that evidence for the efficacy of these therapies is weak. In light of the lack of reliable and effective medications for the management of IBS, there is a growing interest in complementary and alternative forms of therapy.
26
Osteopathy is a complementary health approach that emphasizes the role of the musculoskeletal system in health and promotes optimal function of the tissues of the body by using a variety of manual techniques to improve the function of the body.
27 Outside the United States, osteopathy is gaining popularity for the management of certain illnesses, including gastrointestinal disorders, and a number of peer-reviewed studies
28-31 have examined the effect of osteopathic manipulative therapy (OMTh) for patients with IBS. However, to our knowledge, no systematic review or appraisal of these studies has been performed.
Because a standard for the management of IBS is lacking, the clinical effects of OMTh were examined in the current systematic review. Our objective was to systematically identify and appraise RCTs that used OMTh interventions to manage symptoms of IBS in adult patients.