Table2_An Overview of Systematic Reviews of Herbal Medicine for Irritable Bowel Syndrome.DOCX

Background: Irritable bowel syndrome (IBS) is a common disorder with abdominal pain and bowel habits changes. Herbal medicines (HMs) are frequently used in the treatment of IBS. Therefore, several systematic reviews (SRs) have been conducted to assess the efficacy and safety of HM in IBS patients. This study aimed to investigate the methodology and quality of evidence of SRs, and to describe the current state of research and evidence for the treatment of IBS with HM.Methods: SRs published up to January 2022 were searched using six electronic databases. SRs and/or meta-analyses on the use of HMs for IBS were included. The effects of placebo, conventional medicine (CM), and probiotics were compared with those of HMs. Two investigators independently extracted the data and assessed methodological quality using the Measure Tool to Assessment System Reviews 2 (AMSTAR 2). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the quality of evidence for each main finding.Results: Eighteen SRs were included in this overview. Among them, eight SRs reported only specific subtypes of IBS: six SRs reported patients with diarrhea-predominant IBS, and two SRs reported patients with constipation-predominant IBS. In terms of total efficacy, HM was more effective than placebo, CM, or probiotics. HM showed a more significant effect than CM in relieving independent IBS symptom score (abdominal pain score, diarrhea score, abdominal distension score, stool frequency score, etc.) and recurrence rate. The rate of adverse events was significantly lower with HM compared to CM, and no serious adverse events were reported with HM treatment. According to AMSTAR 2, the methodological quality of the included SRs was extremely low. Furthermore, the quality of evidence for total efficacy was considered low or very low according to the GRADE tool.Conclusion: HM can be considered as an effective and safe treatment for IBS. However, the methodological quality of the included SRs and the quality of evidence was generally low. Therefore, well-designed randomized controlled trials are needed in the future so that a high-quality SR can be used to better assess the safety and efficacy of HM in the treatment of IBS.Systematic Review Registration:https://osf.io/nt6wz, identifier 10.17605/OSF.IO/NT6WZ.

背景：肠易激综合症（IBS）是一种常见的疾病，其主要症状为腹痛和排便习惯的改变。草药药物（HMs）常被用于IBS的治疗。因此，已经进行了多项系统评价（SRs）以评估草药在IBS患者中的疗效与安全性。本研究旨在探究SRs的方法论和质量，并描述以草药治疗IBS的研究现状与证据。方法：至2022年1月，通过六个电子数据库检索了SRs。纳入了针对IBS使用草药的系统评价和/或荟萃分析。将安慰剂、常规药物（CM）和益生菌的效果与草药进行了比较。两位研究人员独立提取数据，并使用评估系统评价测量工具2（AMSTAR 2）评估方法论质量。采用推荐评估、开发与评价（GRADE）系统对每个主要发现的质量进行评估。结果：本综述纳入了18项SRs。其中，8项SRs仅报告了IBS的特定亚型：6项SRs报告了以腹泻为主的IBS患者，2项SRs报告了以便秘为主的IBS患者。在总体疗效方面，草药的疗效优于安慰剂、常规药物或益生菌。草药在缓解独立IBS症状评分（腹痛评分、腹泻评分、腹胀评分、排便频率评分等）和复发率方面显示出比常规药物更显著的效果。与常规药物相比，草药的不良事件发生率显著降低，且在草药治疗中未报告严重的不良事件。根据AMSTAR 2，纳入的SRs的方法论质量极低。此外，根据GRADE工具，总体疗效的证据质量被认为较低或非常低。结论：草药可以被视为一种有效且安全的IBS治疗方法。然而，纳入的SRs的方法论质量和证据质量普遍较低。因此，未来需要设计良好的随机对照试验，以便能够利用高质量的系统评价更好地评估草药在治疗IBS中的安全性和疗效。系统评价注册：https://osf.io/nt6wz，标识符10.17605/OSF.IO/NT6WZ。