Alternative Measures for IBS Management

Abdul Kader Mohiuddin

Abdul Kader Mohiuddin, Secretary & Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka 1215, Bangladesh.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

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Correspondence to: Abdul Kader Mohiuddin, Secretary & Treasurer, Dr. M. Nasirullah Memorial Trust, Tejgaon, Dhaka 1215, Bangladesh.
Email: trymohi@gmail.com
Telephone: +8802-9110553
Orcid Id: https://orcid.org/0000-0003-1596-9757
Web of Science Researcher ID: T-5428-2019

Received: September 26, 2019
Revised: October 17, 2019
Accepted: October 19, 2019
Published online: December 21, 2019


About 30% to 40% of adults claim to have frequent indigestion, and over 50 million visits are made annually to ambulatory care facilities for symptoms related to the digestive system. Irritable bowel syndrome (IBS) is present in patients with symptoms of chronic abdominal pain and altered bowel habits but no identifiable organic etiology. IBS has a prevalence of 1% to 20% worldwide, although up to 75% affected individuals never seek care. Diagnosing IBS can be challenging due to the nonspecific nature of symptoms, overlapping upper and lower abdominal symptoms, and the frequent presence of somatic and psychological comorbidities. Up to 80% of IBS patients identify food as a possible trigger for their symptoms, so they increasingly ask for dietary and behavioral counseling. Moderate-severe IBS is estimated to account for around 60% of all IBS cases and has been shown to impose a considerable burden on patients. It is estimated that IBS-C accounts for around 30% of IBS cases. The economic burden of IBS in the US is estimated at $28 billion annually, a portion of these costs may be related to unnecessary and high-frequency tests, although few studies have assessed the factors underlying frequent tests and procedures among patients with IBS. 32% of IBS-C patients suffer depression as their condition almost every day in the previous month. Sexual dysfunction is positively associated with perceived GI symptom severity and HRQoL.

Key words: Irritable Bowel Syndrome; Low-FODMAP; Cognitive behavioral therapy; Complementary and Alternative Medicine; Chinese Herbal Medicine; Brain-gut axis

© 2019 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Mohiuddin AK. Alternative Measures for IBS Management. Journal of Gastroenterology and Hepatology Research 2019; 8(6): 3025-332 Available from: URL: http://www.ghrnet.org/index.php/joghr/article/view/2694


IBS: Irritable Bowel Syndrome; CBT-IE: Interoceptive Exposure-based CBT program; FODMAP: Fermentable Oligo-, Di-, Mono-saccharides And Polyols; CAM: Complementary and Alternative Medicine

Figure 1 Irritable Bowel Syndrome[1-4]. In particular, IBS is a disease representative of FGIDs in which abdominal pain and discomfort associated with abnormal bowel movements chronically persist and recur. These symptoms are known to be related to lifestyle habits, such as meals and stress. It has been reported that 50% to 90% of patients have or had at some point one or more common psychiatric condition, including major depressive disorder, generalized anxiety disorder, social phobia, somatization disorder, or posttraumatic stress disorder. A survey by the Gastrointestinal Society in Canada showed that nearly 50% had missed work or school due to IBS symptoms. In the US, Canada, and Israel, IBS symptoms are 1.5 to 2 times more prevalent among women than men. Moreover, women are more likely to report abdominal pain and constipation whereas men are more likely to report diarrhea.


Due to disappointing results with conventional IBS treatments, complementary and alternative medicines are becoming attractive options for many patients[5-9]. Up to 50% of patients declared that they used some form of CAM for their GI symptoms, ranging from biologically active compounds to mind-body interventions[10-18]. CAM alone and in conjunction with pharmacological treatments as an integrative approach to manage patients with IBS and improve their QoL[12,19-22]. Prokinetics are not specific to IBS and increase gastrointestinal motility in general by acting via dopamine and 5-HT3 receptors as antagonists or 5-HT4 receptors as agonists[23-31]. Along with prokinetics, treatment revolves around the use of therapies which are not specifically approved/not truly effective for treating IBS-C, such as laxatives, antispasmodics, gastric relaxants, or central neuromodulators and bulking agents (e.g. dietary fibers)[32-40]. Novartis has agreed to continue to supply Zelnorm® (Tegaserod maleate) for use in emergency situations, due to an increased cardiovascular risk[41,42]. Alosetron hydrochloride (Lotronex), voluntarily withdrawn in November 2000 by GlaxoSmithKline, but put back on the market, is the only medication approved for the treatment of severe IBS-D in women who have inadequately responded to conventional therapy[43-47]. However, no studies have evaluated the efficacy of alosetron using the new FDA composite endpoint which requires improvement in both abdominal pain and diarrhea[47,48]. A mixture of dried powdered slippery elm bark, lactulose, oat bran, and licorice root significantly improved both bowel habit and IBS symptoms in patients with IBS-C[49]. More than 95% of patients rated artichoke leaf extract as better than or at least equal to previous therapies administered for their symptoms, and the tolerability was very good[50]. Probiotics may be useful in the management of IBS; however, dose and specific bacterial strain are important[51]. Enteric-coated peppermint oil is a safe and effective therapy for the relief of abdominal pain and global symptoms and in adults with IBS. Menthacarin, the primary component blocks Ca2+ channels and causing the relaxation of intestinal smooth muscle tissue[52-60]. STW 5 is a liquid formulation of nine herbs (Iberis amara totalis recens, Angelicae radix, Cardui mariae fructus, Chelidonii herba, Liquiritiae radix, Matricariae flos, Melissae folium, Carvi fructus and Menthae piperitae folium) used in clinical practice in Germany for more than 50 years, acts beneficially on abdominal symptom clusters as well as on individual GI symptoms in adults and children with efficacy, tolerability, reduced children school absenteeism[61-70]. Turmeric (Curcuma longa) or Java ginger (Curcuma xanthorrhiza) or curcumin, a biologically active phytochemical or combinatiomn with fennel oil was found to be beneficial, improved patient QoL (due to myorelaxant effect towards the intestinal muscle, involves not only the cholinergic receptors, but also L type Calcium channels) but not statistically significant in IBS symptoms (compared with placebo)[50,71-80]. Enzymes comprise the endocannabinoid system in intestinal pain and motility in IBS is also claimed[81] but no significant difference found with dronabinol/nabilone (synthetic compounds containing cannabinoids found in the marijuana plant)[82-86]. Aloe Vera found to be improved QoL with insignificant/no severity symptom reduction in several studies[87-94] and studies show its carcinogenic potential in the colon[90],95-98], nephrotoxicity and hepatotoxicity[95,99-104] which surely demands very limited use unless necessary. Zingier officinale also showed limited potential in symptom management[105-108]. Mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium improved QoL in men but not in women[109]. Although, an earlier study with Mentha longifolia, Cyperus rotundus and Zingiber officinale combination showed significant improvements after 8-weeks of treatment[110]. CAM for IBS include hypnosis, acupuncture, cognitive behavior therapy, yoga, probiotics, meditation, and herbal medicine[12,19,50,111-113]. Yan et al, 2019 and Wu et.al, 2019 and few other studies reported efficiency and safety of acupuncture alone or combined with Moxibustion or other CHM in IBS[12,114-126]. Like Zingier officinale and Curcuma longa, Fumaria officinalis, Hypericum perforatum, Plantago psyllium and Carmint (Mentha spicata, Melissa officinalis, Coriandrum sativum) do not have significant efficacy or at least similar efficacy as placebo is also reported[50]. CHM like Sishen Wan, Ma Zi Ren Wan, CCH1 (patented, modified herb formula), Hemp seed pill, Jianpi Tiaogan Wenshen Recipe (JTWR), Chinese Medicine syndrome-differentiation therapy, Yun-chang capsule, plantain-senna granule (CPSG), Tongxie Yaofang (TXYF) Granule, Changjishu soft elastic capsule, Tongyouqing and many more showed potentials in IBS[127]. The emerging role of brain-gut therapies in IBS are visible. Cognitive behavioral therapy (CBT) and gut-directed hypnosis are the primary behavioral interventions that are introduced to patients with gastrointestinal conditions[128]. IBS involves dysregulation of the brain-gut axis and psychological processes play an important role in the development and maintenance of the disorder[129]. Gut-focused hypnotherapy was found to be effective in primary and secondary care[130-133], but only small changes were found in intestinal microbiota composition[134]. CBT-IE for IBS includes exposure to abdominal sensations in addition to psychoeducation, self-monitoring, cognitive restructuring, attention training, and in vivo exposure, which are often used in traditional CBT[135]. Home-based version of CBT produced significant and sustained gastrointestinal symptom improvement for patients with IBS compared with education[136]. Both web/phone-delivered CBT and home/clinic-based CBT was found to be effective than usual treatment in refractory IBS, resulted in substantial and enduring relief of multiple symptoms[137,138]. Although significant for both outcomes, the statistical analysis revealed CBT interventions have a greater effect on alleviating IBS symptoms severity rather than on reducing psychological distress[139]. Emotional stress exacerbates IBS symptoms, and mind-body interventions may be beneficial. Exercise (yoga, walking/aerobic physical activity, Tai Ji, mountaineering, and Baduanjin qigong activity) is potentially a feasible and effective treatment for IBS patients[140]. Yoga improved sleep, increased visceral sensitivity and reduced abdominal pain in teens[141], adolescents and young adults[142], women[143] and postmenopausal women[144]. Patients with irritable bowel syndrome might benefit from yoga and a low-FODMAP diet, as both groups showed a reduction in gastrointestinal symptoms[145]. Low-FODMAPs, ketogenic gluten-free diets are considered therapeutic[146-150]. However, there are gaps in implementation of the low FODMAP diet in clinical practice, as well as long-term safety and efficacy[151]. A low FODMAP diet is only recommended as a second line treatment guided by qualified clinicians with specialized training[152]. Dietary sources fibers include oats, psyllium, ispaghula, nuts and seeds, some fruit and vegetables and pectins. An increase in fiber has often been suggested as an initial treatment for IBS[153]. There is strong evidence to support three mechanisms of action: (1) Augmentation of small intestinal water; (2) Increased colonic fermentation; (3). Immune modulation[154]. However, water-insoluble fiber does not improve IBS symptoms, consuming soluble fiber improves overall IBS symptoms[155].


I'm thankful to Dr. Elshazaly Saeed F.E.H. Elhassan, King Saud University, Saudi Arabia for his precious time to review my literature and for her thoughtful suggestions. I'm also grateful to seminar library of Faculty of Pharmacy, University of Dhaka and BANSDOC Library, Bangladesh for providing me books, journal and newsletters.


1. Okawa Y, Fukudo S, Sanada H. Specific foods can reduce symptoms of irritable bowel syndrome and functional constipation: a review. Biopsychosoc Med. 2019 May 8; 13: 10. [DOI: 10.1186/s13030-019-0152-5]. eCollection 2019. Review. [PMID: 31080496]; [PMCID: PMC6505279].

2. Abdul Rani R, Raja Ali RA, Lee YY. Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res. 2016 Oct; 14(4): 297-304. Epub 2016 Oct 17. Review. [PMID: 27799880]; [PMCID: PMC5083258].

3. Mohiuddin AK. Alternative Treatments for Minor GI Ailments. INNOVATIONS in pharmacy Vol 10, No 3, (2019) / Insights. [DOI: 10.24926/iip.v10i3.1659]

4. Patel N, Shackelford KS. Irritable Syndrome Syndrome. Updated 2019 Jan 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534810/

5. Rahimi R, Abdollahi M. Herbal medicines for the management of irritable bowel syndrome: a comprehensive review. World J Gastroenterol. 2012 Feb 21; 18(7): 589-600. [DOI: 10.3748/wjg.v18].i7.589. Review. [PMID: 22363129]; [PMCID: PMC3281215]

6. Wu JC. Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: facts or myths? Gastroenterol Hepatol (N Y). 2010 Nov; 6(11): 705-11. [PMID: 21437019]; [PMCID: PMC3033541]

7. Adeyemo MA, Chang L. New treatments for irritable bowel syndrome in women. Womens Health (Lond). 2008 Nov; 4(6): 605-22; quiz 623. [DOI: 10.2217/17455057.4.6.605]. Review. [PMID: 19072463]; [PMCID: PMC2652519]

8. Peyton L, Greene J. Irritable bowel syndrome: current and emerging treatment options. P T. 2014 Aug; 39(8): 567-78. [PMID: 25136255]; [PMCID: PMC4123807]

9. Anastasi JK, Capili B, Chang M. Managing irritable bowel syndrome. Am J Nurs. 2013 Jul; 113(7): 42-52; quiz 54, 53. [DOI: 10.1097/01.NAJ.0000431911.65473.35]. Review. [PMID: 23764698]; [PMCID: PMC5654469]

10. Larussa T, Rossi M, Suraci E, Marasco R, Imeneo M, Abenavoli L, Luzza F. Use of Complementary and Alternative Medicine by Patients with Irritable Bowel Syndrome According to the Roma IV Criteria: A Single-Center Italian Survey. Medicina (Kaunas). 2019 Feb 13; 55(2). pii: E46. [DOI: 10.3390/medicina55020046]; [PMID: 30781771]; [PMCID: PMC6409648]

11. Nguyen L. Complementary and Alternative Medicine for the Management of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2018 Sep; 14(9): 536-538. [PMID: 30364316]; [PMCID: PMC6194653.

12. Shen YH, Nahas R. Complementary and alternative medicine for treatment of irritable bowel syndrome. Can Fam Physician. 2009 Feb; 55(2): 143-8. Review. [PMID: 19221071]; [PMCID: PMC2642499]

13. Chiarioni G, Pesce M, Fantin A, Sarnelli G. Complementary and alternative treatment in functional dyspepsia. United European Gastroenterol J. 2018 Feb; 6(1): 5-12. [DOI: 10.1177/2050640617724061]. Epub 2017 Aug 2. Review. [PMID: 29435308]; [PMCID: PMC5802680].

14. Tabish SA. Complementary and Alternative Healthcare: Is it Evidence-based? Int J Health Sci (Qassim). 2008 Jan; 2(1): V-IX. [PMID: 21475465; [PMCID: PMC3068720" target="new">[PMCID: PMC3068720" target="new">[PMID: 21475465; [PMCID: PMC3068720]

15. Callahan LF, Wiley-Exley EK, Mielenz TJ, Brady TJ, Xiao C, Currey SS, Sleath BL, Sloane PD, DeVellis RF, Sniezek J. Use of complementary and alternative medicine among patients with arthritis. Prev Chronic Dis. 2009 Apr; 6(2): A44. Epub 2009 Mar 16. [PMID: 19288987]; [PMCID: PMC2687850]

16. Goldenberg JZ, Steel A, Day A, Yap C, Bradley R, Cooley K. Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics. Integr Med Res. 2018 Sep; 7(3): 279-286. [DOI: 10.1016/j.imr.2018.06.001]. Epub 2018 Jun 9. [PMID: 30271717]; [PMCID: PMC6160506]

17. Lail G, Luck N, Tasneem AA, Rai A, Laeeq SM, Majid Z. The usage of complementary and alternative medicine in gastrointestinal patients visiting the outpatients' department of a large tertiary care centre-views from Pakistan. Pan Afr Med J. 2016 Jul 15; 24: 247. eCollection 2016. [PMID: 27800102]; [PMCID: PMC5075463].

18. Brien SB, Bishop FL, Riggs K, Stevenson D, Freire V, Lewith G. Integrated medicine in the management of chronic illness: a qualitative study. Br J Gen Pract. 2011 Feb; 61(583): e89-96. [DOI: 10.3399/bjgp11X556254]; [PMID: 21276333]; [PMCID: PMC3026175].

19. Grundmann O, Yoon SL. Complementary and alternative medicines in irritable bowel syndrome: an integrative view. World J Gastroenterol. 2014; 20(2): 346-62.

20. Harris LR, Roberts L. Treatments for irritable bowel syndrome: patients' attitudes and acceptability. BMC Complement Altern Med. 2008 Dec 19; 8: 65. [DOI: 10.1186/1472-6882-8-65]; [PMID: 19099570]; [PMCID: PMC2633319].

21. Hussain Z, Quigley EM. Systematic review: Complementary and alternative medicine in the irritable bowel syndrome. Aliment Pharmacol Ther. 2006 Feb 15; 23(4): 465-71. Review. [PMID: 16441466].

22. Usher, Lee, Pauline Fox, Caroline Lafarge, & Kathryn Mitchell. "Factors Associated With Complementary and Alternative Medicine Use in Irritable Bowel Syndrome: A Literature Review." Psychology, Community & Health (Online), 2.3 (2013): 346-361. Web. 27 Aug. 2019

23. Jadallah KA, Kullab SM, Sanders DS. Constipation-predominant irritable bowel syndrome: a review of current and emerging drug therapies. World J Gastroenterol. 2014 Jul 21; 20(27): 8898-909. [DOI: 10.3748/wjg.v20.i27.8898]. Review. [PMID: 25083062]; [PMCID: PMC4112860].

24. Sinagra E, Morreale GC, Mohammadian G, Fusco G, Guarnotta V, Tomasello G, Cappello F, Rossi F, Amvrosiadis G, Raimondo D. New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond. World J Gastroenterol. 2017 Sep 28; 23(36): 6593-6627. [DOI: 10.3748/wjg.v23.i36.6593]. Review. [PMID: 29085207]; [PMCID: PMC5643283].

25. Lang L. The Food and Drug Administration approves lubiprostone for irritable bowel syndrome with constipation. Gastroenterology. 2008 Jul; 135(1): 7. [DOI: 10.1053/j.gastro.2008.06.004]. Epub 2008 Jun 9. [PMID: 18541153].

26. Sweetser S, Busciglio IA, Camilleri M, Bharucha AE, Szarka LA, Papathanasopoulos A, Burton DD, Eckert DJ, Zinsmeister AR. Effect of a chloride channel activator, lubiprostone, on colonic sensory and motor functions in healthy subjects. Am J Physiol Gastrointest Liver Physiol. 2009 Feb; 296(2): G295-301. [DOI: 10.1152/ajpgi.90558.2008]. Epub 2008 Nov 25. [PMID: 19033530]; [PMCID: PMC2643920].

27. Moayyedi P, Mearin F, Azpiroz F, Andresen V, Barbara G, Corsetti M, Emmanuel A, Hungin APS, Layer P, Stanghellini V, Whorwell P, Zerbib F, Tack J. Irritable bowel syndrome diagnosis and management: A simplified algorithm for clinical practice. United European Gastroenterol J. 2017 Oct; 5(6): 773-788. [DOI: 10.1177/2050640617731968]. Epub 2017 Sep 28. Review. [PMID: 29026591]; [PMCID: PMC5625880].

28. Tameez Ud Din A, Khan AH, Bajwa H, Maqsood MH, Malik MN. Clinical Efficacy and Safety Profile of Prucalopride in Chronic Idiopathic Constipation. Cureus. 2019 Apr 4; 11(4): e4382. [DOI: 10.7759/cureus.4382]. Review. [PMID: 31218146]; [PMCID: PMC6553670].

29. Stefano Evangelista, "Benefits from Long-Term Treatment in Irritable Bowel Syndrome," Gastroenterology Research and Practice, vol. 2012, Article ID 936960, 6 pages, 2012. [DOI: 10.1155/2012/936960].

30. 1: Quigley EMM. Prokinetics in the Management of Functional Gastrointestinal Disorders. Curr Gastroenterol Rep. 2017 Sep 8; 19(10): 53. [DOI: 10.1007/s11894-017-0593-6]. Review. [PMID: 28887755].

31. Bellini M, Gambaccini D, Stasi C, Urbano MT, Marchi S, Usai-Satta P. Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy. World J Gastroenterol. 2014 Jul 21; 20(27): 8807-20. [DOI: 10.3748/wjg.v20.i27.8807]. Review. [PMID: 25083055]; [PMCID: PMC4112881].

32. Tack J, Stanghellini V, Mearin F, Yiannakou Y, Layer P, Coffin B, Simren M, Mackinnon J, Wiseman G, Marciniak A; IBIS-C Study group. Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries. BMC Gastroenterol. 2019 May 7; 19(1): 69. [DOI: 10.1186/s12876-019-0985-1]. [PMID: 31064345]; [PMCID: PMC6505116].

33. Wang XJ, Camilleri M. Personalized medicine in functional gastrointestinal disorders: Understanding pathogenesis to increase diagnostic and treatment efficacy. World J Gastroenterol. 2019 Mar 14; 25(10): 1185-1196. [DOI: 10.3748/wjg.v25.i10.1185]. Review. [PMID: 30886502]; [PMCID: PMC6421234].

34. Talley NJ. Evaluation of drug treatment in irritable bowel syndrome. Br J Clin Pharmacol. 2003 Oct; 56(4): 362-9. Review. Erratum in: Br J Clin Pharmacol. 2003 Nov; 56(5): 584. [PMID: 12968980]; [PMCID: PMC1884360].

35. Occhipinti K, Smith JW. Irritable bowel syndrome: a review and update. Clin Colon Rectal Surg. 2012 Mar; 25(1): 46-52. [DOI: 10.1055/s-0032-1301759]; [PMID: 23449495]; [PMCID: PMC3348735].

36. Furnari M, de Bortoli N, Martinucci I, Bodini G, Revelli M, Marabotto E, Moscatelli A, Del Nero L, Savarino E, Giannini EG, Savarino V. Optimal management of constipation associated with irritable bowel syndrome. Ther Clin Risk Manag. 2015 May 30; 11: 691-703. [DOI: 10.2147/TCRM.S54298]. eCollection 2015. Review. [PMID: 26028974]; [PMCID: PMC4425337].

37. Annaházi A, Róka R, Rosztóczy A, Wittmann T. Role of antispasmodics in the treatment of irritable bowel syndrome. World J Gastroenterol. 2014 May 28; 20(20): 6031-43. [DOI: 10.3748/wjg.v20.i20.6031]. Review. [PMID: 24876726]; [PMCID: PMC4033443].

38. Reina J, Smith JW. Medical treatment of irritable bowel syndrome. Clin Colon Rectal Surg. 2005 May; 18(2): 102-8. [DOI: 10.1055/s-2005-870891]; [PMID: 20011349]; [PMCID: PMC2780138].

39. Hammerle CW, Surawicz CM. Updates on treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7; 14(17): 2639-49. Review. [PMID: 18461649]; [PMCID: PMC2709043].

40. Basnayake C. Treatment of irritable bowel syndrome. Aust Prescr. 2018 Oct; 41(5): 145-149. [DOI: 10.18773/austprescr.2018.044]. Epub 2018 Oct 1. Review. [PMID: 30410210]; [PMCID: PMC6202292].

41. US FDA Admin Web. Zelnorm (tegaserod maleate) Information. Available From: https://www.fda.gov/Drugs/DrugSafety/ucm103223.htm

42. KEY POINT. Tegaserod withdrawn from U.S. market. APhA Drug Info Online Web April 1, 2007.

43. WHO Web. Alosetron - withdrawn: severe adverse reactions. Available From: http://apps.who.int/medicinedocs/en/d/Jh1466e/2.3.html

44. Charatan F. FDA advisory panels recommend Lotronex be put back on market. BMJ. 2002 May 4; 324(7345): 1053. [PMID: 11993482]; [PMCID: PMC1123017].

45. Moynihan R. Alosetron: a case study in regulatory capture, or a victory for patients' rights? BMJ. 2002 Sep 14; 325(7364): 592-5. Review. [PMID: 12228140]; [PMCID: PMC1124108].

46. Lucak SL. Optimizing outcomes with alosetron hydrochloride in severe diarrhea-predominant irritable bowel syndrome. Therap Adv Gastroenterol. 2010 May; 3(3): 165-72. [DOI: 10.1177/1756283X10362277]; [PMID: 21180598]; [PMCID: PMC3002579].

47. Lacy BE, Nicandro JP, Chuang E, Earnest DL. Alosetron use in clinical practice: significant improvement in irritable bowel syndrome symptoms evaluated using the US Food and Drug Administration composite endpoint. Therap Adv Gastroenterol. 2018 May 8; 11: 1756284818771674. [DOI: 10.1177/1756284818771674]; eCollection 2018. [PMID: 29774051]; [PMCID: PMC5949923].

48. U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER). Guidance for industry: irritable bowel syndrome--clinical evaluation of drugs for treatment, http://www.fda.gov/downloads/Drugs/Guidances/UCM205269.pdf

49. Hawrelak JA, Myers SP. Effects of two natural medicine formulations onirritable bowel syndrome symptoms: a pilot study. J Altern Complement Med. 2010Oct; 16(10): 1065-71. [DOI: 10.1089/acm.2009.0090]; [PMID: 20954962].

50. Bahrami HR, Hamedi S, Salari R, Noras M. Herbal Medicines for the Management of Irritable Bowel Syndrome: A Systematic Review. Electron Physician. 2016 Aug 25; 8(8): 2719-2725. eCollection 2016 Aug. [PMID: 27757180]; [PMCID: PMC5053451].

51. National Collaborating Centre for Nursing and Supportive Care (UK). Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]. London: Royal College of Nursing (UK); 2008 Feb. (NICE Clinical Guidelines, No. 61.) 7, Diet and lifestyle. Available from: https://www.ncbi.nlm.nih.gov/books/NBK51960/

52. Alammar N, Wang L, Saberi B, Nanavati J, Holtmann G, Shinohara RT, Mullin GE. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019 Jan 17; 19(1): 21. [DOI: 10.1186/s12906-018-2409-0]; [PMID: 30654773]; [PMCID: PMC6337770].

53. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul; 48(6): 505-12. [DOI: 10.1097/MCG.0b013e3182a88357]. Review. [PMID: 24100754].

54. Cash BD, Epstein MS, Shah SM. A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms. Dig Dis Sci. 2016 Feb; 61(2): 560-71. [DOI: 10.1007/s10620-015-3858-7]. Epub 2015 Aug 29. [PMID: 26319955]; [PMCID: PMC4729798].

55. Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005 Aug; 12(8): 601-6. Review. [PMID: 16121521].

56. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010 May; 55(5): 1385-90. [DOI: 10.1007/s10620-009-0854-9]. Epub 2009 Jun 9. [PMID: 19507027].

57. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007 Jun; 39(6): 530-6. Epub 2007 Apr 8. [PMID: 17420159].

58. Wall GC, Bryant GA, Bottenberg MM, Maki ED, Miesner AR. Irritable bowel syndrome: a concise review of current treatment concepts. World J Gastroenterol. 2014 Jul 21; 20(27): 8796-806. [DOI: 10.3748/wjg.v20.i27.8796]. Review. [PMID: 25083054]; [PMCID: PMC4112883].

59. Chumpitazi BP, Kearns GL, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther. 2018 Mar; 47(6): 738-752. [DOI: 10.1111/apt.14519]. Epub 2018 Jan 26. Review. [PMID: 29372567]; [PMCID: PMC5814329].

60. Fifi AC, Axelrod CH, Chakraborty P, Saps M. Herbs and Spices in the Treatment of Functional Gastrointestinal Disorders: A Review of Clinical Trials. Nutrients. 2018 Nov 9; 10(11). pii: E1715. [DOI: 10.3390/nu10111715]. Review. [PMID: 30423929]; [PMCID: PMC6266883].

61. Gundermann K.J., Vinson B. Die funktionelle Dyspepsie bei Kindern-eine retrospektive Studie mit einem Phytopharmakon. Päd. 2004; 10: 1-6.

62. Malfertheiner P. STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders. Dig Dis. 2017; 35 Suppl 1: 25-29. [DOI: 10.1159/000485410]. Epub 2018 Feb 8. Review. [PMID: 29421817].

63. Ottillinger B, Storr M, Malfertheiner P, Allescher HD. STW 5 (Iberogast®)--a safe and effective standard in the treatment of functional gastrointestinal disorders. Wien Med Wochenschr. 2013 Feb; 163(3-4): 65-72. [DOI: 10.1007/s10354-012-0169-x]. Epub 2012 Dec 20. Review. [PMID: 23263639]; [PMCID: PMC3580135].

64. Lapina TL, Trukhmanov AS. Herbal Preparation STW 5 for Functional Gastrointestinal Disorders: Clinical Experience in Everyday Practice. Dig Dis. 2017; 35 Suppl 1: 30-35. [DOI: 10.1159/000485411]. Epub 2018 Feb 8. Review. [PMID: 29421814].

65. Allescher HD, Abdel-Aziz H. Mechanism of Action of STW 5 in Functional Dyspepsia and IBS: The Origin of Multi-Target. Dig Dis. 2017; 35 Suppl 1: 18-24. [DOI: 10.1159/000485456]. Epub 2018 Feb 8. Review. [PMID: 29421789].

66. Raedsch R, Vinson B, Ottillinger B, Holtmann G. Early onset of efficacy in patients with functional and motility-related gastrointestinal disorders: A noninterventional study with Iberogast®. Wien Med Wochenschr. 2018 Mar; 168(3-4): 89-98. [DOI: 10.1007/s10354-017-0578-y]. Epub 2017 Jul 25. [PMID: 28744774]; [PMCID: PMC5820387].

67. Mearin F, Malfertheiner P. Functional Gastrointestinal Disorders: Complex Treatments for Complex Pathophysiological Mechanisms. Dig Dis. 2017; 35 Suppl 1: 1-4. [DOI: 10.1159/000485407]. Epub 2018 Feb 8. [PMID: 29421797]; [PMCID: PMC6067652].

68. Abdel-Aziz H, Kelber O, Lorkowski G, Storr M. Evaluating the Multitarget Effects of Combinations through Multistep Clustering of Pharmacological Data: the Example of the Commercial Preparation Iberogast. Planta Med. 2017 Oct; 83(14-15): 1130-1140. [DOI: 10.1055/s-0043-116852]. Epub 2017 Aug 31. Review. [PMID: 28859216]; [PMCID: PMC6193281].

69. Ochoa-Cortes F, Liñán-Rico A, Jacobson KA, Christofi FL. Potential for developing purinergic drugs for gastrointestinal diseases. Inflamm Bowel Dis. 2014 Jul; 20(7): 1259-87. [DOI: 10.1097/MIB.0000000000000047]. Review. [PMID: 24859298]; [PMCID: PMC4340257].

70. Madisch A, Vinson BR, Abdel-Aziz H, Kelber O, Nieber K, Kraft K, Storr M. Modulation of gastrointestinal motility beyond metoclopramide and domperidone: Pharmacological and clinical evidence for phytotherapy in functional gastrointestinal disorders. Wien Med Wochenschr. 2017 May; 167(7-8): 160-168. [DOI: 10.1007/s10354-017-0557-3]. Epub 2017 Apr 19. Review. [PMID: 28424994]; [PMCID: PMC5409921].

71. Ng QX, Soh AYS, Loke W, Venkatanarayanan N, Lim DY, Yeo WS. A Meta-Analysis of the Clinical Use of Curcumin for Irritable Bowel Syndrome (IBS). J Clin Med. 2018 Sep 22; 7(10). pii: E298. [DOI: 10.3390/jcm7100298]; [PMID: 30248988]; [PMCID: PMC6210149].

72. Bundy R, Walker AF, Middleton RW, Booth J. Turmeric extract may improve irritable bowel syndrome symptomology in otherwise healthy adults: a pilot study. J Altern Complement Med. 2004 Dec; 10(6): 1015-8. [PMID: 15673996].

73. Dulbecco P, Savarino V. Therapeutic potential of curcumin in digestive diseases. World J Gastroenterol. 2013 Dec 28; 19(48): 9256-70. [DOI: 10.3748/wjg.v19.i48.9256]. Review. [PMID: 24409053]; [PMCID: PMC3882399].

74. Kandola A. Turmeric for IBS: Does it work? MedicalNewsToday, 5 December 2018.

75. Micucci M, Aldini R, Cevenini M, Colliva C, Spinozzi S, Roda G, Montagnani M, Camborata C, Camarda L, Chiarini A, Mazzella G, Budriesi R. Curcuma longa L. as a therapeutic agent in intestinal motility disorders. 2: Safety profile in mouse. PLoS One. 2013 Nov 18; 8(11): e80925. [DOI: 10.1371/journal.pone.0080925]. eCollection 2013. [PMID: 24260512]; [PMCID: PMC3832444].

76. Khan I, Samson SE, Grover AK. Antioxidant Supplements and Gastrointestinal Diseases: A Critical Appraisal. Med Princ Pract. 2017; 26(3): 201-217. [DOI: 10.1159/000468988]. Epub 2017 Mar 8. [PMID: 28278495]; [PMCID: PMC5588418].

77. Di Ciaula A, Portincasa P, Maes N, Albert A. Efficacy of bio-optimized extracts of turmeric and essential fennel oil on the quality of life in patients with irritable bowel syndrome. Ann Gastroenterol. 2018 Nov-Dec; 31(6): 685-691. [DOI: 10.20524/aog.2018.0304]. Epub 2018 Aug 6. [PMID: 30386118]; [PMCID: PMC6191874].

78. Portincasa P, Bonfrate L, de Bari O, Lembo A, Ballou S. Irritable bowel syndrome and diet. Gastroenterol Rep (Oxf). 2017 Feb; 5(1): 11-19. [DOI: 10.1093/gastro/gow047]. Epub 2017 Jan 20. Review. [PMID: 28110300]; [PMCID: PMC5444258].

79. Portincasa P, Bonfrate L, Scribano ML, Kohn A, Caporaso N, Festi D, Campanale MC, Di Rienzo T, Guarino M, Taddia M, Fogli MV, Grimaldi M, Gasbarrini A. Curcumin and Fennel Essential Oil Improve Symptoms and Quality of Life in Patients with Irritable Bowel Syndrome. J Gastrointestin Liver Dis. 2016 Jun; 25(2): 151-7. [DOI: 10.15403/jgld.2014.1121.252.ccm]; [PMID: 27308645].

80. Lakhan SE, Ford CT, Tepper D. Zingiberaceae extracts for pain: a systematic review and meta-analysis. Nutr J. 2015 May 14; 14: 50. [DOI: 10.1186/s12937-015-0038-8]. Review. [PMID: 25972154]; [PMCID: PMC4436156].

81. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb; 4(1): 245-59. [PMID: 18728714]; [PMCID: PMC2503660].

82. Wong BS, Camilleri M, Eckert D, Carlson P, Ryks M, Burton D, Zinsmeister AR. Randomized pharmacodynamic and pharmacogenetic trial of dronabinol effects on colon transit in irritable bowel syndrome-diarrhea. Neurogastroenterol Motil. 2012 Apr; 24(4): 358-e169. [DOI: 10.1111/j.1365-2982.2011.01874.x]. Epub 2012 Jan 30. [PMID: 22288893]; [PMCID: PMC3775711].

83. Klooker TK, Leliefeld KE, Van Den Wijngaard RM, Boeckxstaens GE. The cannabinoid receptor agonist delta-9-tetrahydrocannabinol does not affect visceral sensitivity to rectal distension in healthy volunteers and IBS patients. Neurogastroenterol Motil. 2011 Jan; 23(1): 30-5, e2. [DOI: 10.1111/j.1365-2982.2010.01587.x]. Epub 2010 Aug 16. [PMID: 20718944].

84. Bokic T, Storr M, Schicho R. Potential Causes and Present Pharmacotherapy of Irritable Bowel Syndrome: An Overview. Pharmacology. 2015; 96(1-2): 76-85. [DOI: 10.1159/000435816]. Epub 2015 Jul 1. Review. [PMID: 26139425]; [PMCID: PMC4541721].

85. Fraguas-Sánchez AI, Torres-Suárez AI. Medical Use of Cannabinoids. Drugs. 2018 Nov; 78(16): 1665-1703. [DOI: 10.1007/s40265-018-0996-1]. Review. [PMID: 30374797].

86. Halawi H, Camilleri M. Pharmacogenetics and the treatment of functional gastrointestinal disorders. Pharmacogenomics. 2017 Jul; 18(11): 1085-1094. [DOI: 10.2217/pgs-2017-0049]. Epub 2017 Jul 7. Review. [PMID: 28686075]; [PMCID: PMC5591464].

87. Davis K, Philpott S, Kumar D, Mendall M. Randomised double-blind placebo-controlled trial of aloe vera for irritable bowel syndrome. Int J Clin Pract. 2006 Sep; 60(9): 1080-6. Epub 2006 Jun 2. [PMID: 16749917].

88. Hutchings HA, Wareham K, Baxter JN, Atherton P, Kingham JG, Duane P, Thomas L, Thomas M, Ch'ng CL, Williams JG. A Randomised, Cross-Over, Placebo-Controlled Study of Aloe vera in Patients with Irritable Bowel Syndrome: Effects on Patient Quality of Life. ISRN Gastroenterol. 2011; 2011: 206103. [DOI: 10.5402/2011/206103]. Epub 2010 Oct 11. [PMID: 21991499]; [PMCID: PMC3168391].

89. Størsrud S, Pontén I, Simrén M. A Pilot Study of the Effect of Aloe barbadensis Mill. Extract (AVH200®) in Patients with Irritable Bowel Syndrome: a Randomized, Double-Blind, Placebo-Controlled Study. J Gastrointestin Liver Dis. 2015 Sep; 24(3): 275-80. [DOI: 10.15403/jgld.2014.1121.243.sst]; [PMID: 26405698].

90. Hong SW, Chun J, Park S, Lee HJ, Im JP, Kim JS. Aloe vera Is Effective and Safe in Short-term Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2018 Oct 1; 24(4): 528-535. [DOI: 10.5056/jnm18077]. Review. [PMID: 30153721]; [PMCID: PMC6175553].

91. Khedmat H, Karbasi A, Amini M, Aghaei A, Taheri S. Aloe vera in treatment of refractory irritable bowel syndrome: Trial on Iranian patients. J Res Med Sci. 2013 Aug; 18(8): 732. [PMID: 24379854]; [PMCID: PMC3872617].

92. Kandola A. Is Aloe vera juice good for IBS? MedicalNewsToday, 7 January 2018.

93. Foster M, Hunter D, Samman S. Evaluation of the Nutritional and Metabolic Effects of Aloe vera. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92765/

94. Lacy BE, Weiser K, De Lee R. The treatment of irritable bowel syndrome. Therap Adv Gastroenterol. 2009 Jul; 2(4): 221-38. [DOI: 10.1177/1756283X09104794]; [PMID: 21180545]; [PMCID: PMC3002524].

95. Guo X, Mei N. Aloe vera: A review of toxicity and adverse clinical effects. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2016 Apr 2; 34(2): 77-96. [DOI: 10.1080/10590501.2016.1166826]. Review. [PMID: 26986231]; [PMCID: PMC6349368].

96. Boudreau MD, Mellick PW, Olson GR, Felton RP, Thorn BT, Beland FA. Clear evidence of carcinogenic activity by a whole-leaf extract of Aloe barbadensis miller (aloe vera) in F344/N rats. Toxicol Sci. 2013 Jan; 131(1): 26-39. [DOI: 10.1093/toxsci/kfs275]. Epub 2012 Sep 11. [PMID: 22968693]; [PMCID: PMC3537128].

97. Boudreau MD, Beland FA, Nichols JA, Pogribna M. Toxicology and carcinogenesis studies of a nondecolorized [corrected] whole leaf extract of Aloe barbadensis Miller (Aloe vera) in F344/N rats and B6C3F1 mice (drinking water study). Natl Toxicol Program Tech Rep Ser. 2013 Aug; (577): 1-266. Erratum in: Natl Toxicol Program Tech Rep Ser. 2013 Aug; (577): 1. [PMID: 24042237].

98. Boudreau MD, Olson GR, Tryndyak VP, Bryant MS, Felton RP, Beland FA. From the Cover: Aloin, a Component of the Aloe Vera Plant Leaf, Induces Pathological Changes and Modulates the Composition of Microbiota in the Large Intestines of F344/N Male Rats. Toxicol Sci. 2017 Aug 1; 158(2): 302-318. [DOI: 10.1093/toxsci/kfx105]; [PMID: 28525602]; [PMCID: PMC5837434].

99. Yang HN, Kim DJ, Kim YM, Kim BH, Sohn KM, Choi MJ, Choi YH. Aloe-induced toxic hepatitis. J Korean Med Sci. 2010 Mar; 25(3): 492-5. [DOI: 10.3346/jkms.2010.25.3.492]. Epub 2010 Feb 17. [PMID: 20191055]; [PMCID: PMC2826749].

100. Bottenberg MM, Wall GC, Harvey RL, Habib S. Oral aloe vera-induced hepatitis. Ann Pharmacother. 2007 Oct; 41(10): 1740-3. Epub 2007 Aug 28. [PMID: 17726067].

101. Lee J, Lee MS, Nam KW. Acute toxic hepatitis caused by an aloe vera preparation in a young patient: a case report with a literature review. Korean J Gastroenterol. 2014 Jul; 64(1): 54-8. Review. [PMID: 25073673].

102. Curciarello J, De Ortúzar S, Borzi S, Bosia D. [Severe acute hepatitis associated with intake of Aloe vera tea]. Gastroenterol Hepatol. 2008 Aug-Sep; 31(7): 436-8. Spanish. [PMID: 18783689].

103. Frenzel C, Teschke R. Herbal Hepatotoxicity: Clinical Characteristics and Listing Compilation. Int J Mol Sci. 2016 Apr 27; 17(5). pii: E588. [DOI: 10.3390/ijms17050588]. Review. [PMID: 27128912]; [PMCID: PMC4881436].

104. Saka W, Akhigbe R, Popoola O, Oyekunle O. Changes in Serum Electrolytes, Urea, and Creatinine in Aloe Vera-treated Rats. J Young Pharm. 2012 Apr; 4(2): 78-81. [DOI: 10.4103/0975-1483.96620]; [PMID: 22754258]; [PMCID: PMC3385221].

105. van Tilburg MA, Palsson OS, Ringel Y, Whitehead WE. Is ginger effective for the treatment of irritable bowel syndrome? A double blind randomized controlled pilot trial. Complement Ther Med. 2014 Feb; 22(1): 17-20. [DOI: 10.1016/j.ctim.2013.12.015]. Epub 2014 Jan 8. [PMID: 24559811]; [PMCID: PMC3958926].

106. Yuki M, Komazawa Y, Kobayashi Y, Kusunoki M, Takahashi Y, Nakashima S, Uno G, Ikuma I, Shizuku T, Kinoshita Y. Effects of Daikenchuto on Abdominal Bloating Accompanied by Chronic Constipation: A Prospective, Single-Center Randomized Open Trial. Curr Ther Res Clin Exp. 2015 May 4; 77: 58-62. [DOI: 10.1016/j.curtheres.2015.04.002]. eCollection 2015 Dec. [PMID: 27069528]; [PMCID: PMC4812817].

107. Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Hu TH. Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011 Jan 7; 17(1): 105-10. [DOI: 10.3748/wjg.v17.i1.105]; [PMID: 21218090]; [PMCID: PMC3016669].

108. Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr. 2018 Nov 5; 7(1): 96-108. [DOI: 10.1002/fsn3.807]. eCollection 2019 Jan. Review. [PMID: 30680163]; [PMCID: PMC6341159].

109. Kazemian A, Toghiani A, Shafiei K, Afshar H, Rafiei R, Memari M, Adibi P. Evaluating the efficacy of mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium on severity of symptoms, anxiety, and depression in irritable bowel syndrome patients. J Res Med Sci. 2017 Nov 28; 22: 120. [DOI: 10.4103/jrms.JRMS_905_16]. eCollection 2017. [PMID: 29259631]; [PMCID: PMC5721494].

110. Sahib AS. Treatment of irritable bowel syndrome using a selected herbal combination of Iraqi folk medicines. J Ethnopharmacol. 2013 Jul 30; 148(3): 1008-12. [DOI: 10.1016/j.jep.2013.05.034]. Epub 2013 May 23. [PMID: 23707209].

111. Lichtenstein GR. Brain-Gut Therapies and Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2018 Jul; 14(7): 399. [PMID: 30166955]; [PMCID: PMC6111499].

112. Lin SC, Cheifetz AS. The Use of Complementary and Alternative Medicine in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2018 Jul; 14(7): 415-425. [PMID: 30166957]; [PMCID: PMC6111500].

113. Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol. 2019 Apr; 2(1): 6-29. [DOI: 10.1093/jcag/gwy071]. Epub 2019 Jan 17. [PMID: 31294724]; [PMCID: PMC6507291].

114. Yan J, Miao ZW, Lu J, Ge F, Yu LH, Shang WB, Liu LN, Sun ZG. Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2019 Apr 14; 2019: 7680963. [DOI: 10.1155/2019/7680963]. eCollection 2019. Review. [PMID: 31110553]; [PMCID: PMC6487118].

115. Wu IXY, Wong CHL, Ho RST, Cheung WKW, Ford AC, Wu JCY, Mak ADP, Cramer H, Chung VCH. Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis. Therap Adv Gastroenterol. 2019 Jan 20; 12: 1756284818820438. [DOI: 10.1177/1756284818820438]. eCollection 2019. [PMID: 30719074]; [PMCID: PMC6348567].

116. 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 May 16; (5): CD005111. [DOI: 10.1002/14651858.CD005111.pub3]. Review. [PMID: 22592702]; [PMCID: PMC3718572].

117. Chao GQ, Zhang S. Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2014 Feb 21; 20(7): 1871-7. [DOI: 10.3748/wjg.v20.i7.1871]; [PMID: 24587665]; [PMCID: PMC3930986].

118. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006 Oct 18; (4): CD005111. Review. Update in: Cochrane Database Syst Rev. 2012; 5: CD005111. [PMID: 17054239].

119. Li CY, Li SC. Treatment of irritable bowel syndrome in China: a review. World J Gastroenterol. 2015 Feb 28; 21(8): 2315-22. [DOI: 10.3748/wjg.v21.i8.2315]. Review. [PMID: 25741137]; [PMCID: PMC4342906].

120. Ma XP, Hong J, An CP, Zhang D, Huang Y, Wu HG, Zhang CH, Meeuwsen S. Acupuncture-moxibustion in treating irritable bowel syndrome: how does it work? World J Gastroenterol. 2014 May 28; 20(20): 6044-54. [DOI: 10.3748/wjg.v20.i20.6044]. Review. [PMID: 24876727]; [PMCID: PMC4033444].

121. Anastasi JK, Capili B. The Treatment of Constipation-Predominant Irritable Bowel Syndrome with Acupuncture and Moxibustion: A Case Report. J Chin Med. 2012 Jun; 99: 68-71. [PMID: 29051677]; [PMCID: PMC5644494].

122. Anastasi JK, Capili B, Chang M. Development of Acupuncture and Moxibustion Protocol in a Clinical Trial for Irritable Bowel Syndrome. J Acupunct Meridian Stud. 2017 Jan; 10(1): 62-66. [DOI: 10.1016/j.jams.2016.12.006]. Epub 2017 Jan 12. [PMID: 28254106]; [PMCID: PMC5572756].

123. Lin X, Liu X, Xu J, Cheng KK, Cao J, Liu T, Liu Q, Zhong H, Shen G, Dong J, Chang X. Metabolomics analysis of herb-partitioned moxibustion treatment on rats with diarrhea-predominant irritable bowel syndrome. Chin Med. 2019 May 8; 14: 18. [DOI: 10.1186/s13020-019-0240-2]. eCollection 2019. [PMID: 31080495]; [PMCID: PMC6505125].

124. Park JW, Lee BH, Lee H. Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis. BMC Complement Altern Med. 2013 Oct 2; 13: 247. [DOI: 10.1186/1472-6882-13-247]. Review. [PMID: 24088418]; [PMCID: PMC3851749].

125. 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 Jun; 107(6): 835-47; quiz 848. [DOI: 10.1038/ajg.2012.66]. Epub 2012 Apr 10. Review. [PMID: 22488079]; [PMCID: PMC3671917].

126. Forbes A, Jackson S, Walter C, Quraishi S, Jacyna M, Pitcher M. Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. World J Gastroenterol. 2005 Jul 14; 11(26): 4040-4. [PMID: 15996029]; [PMCID: PMC4502100].

127. Teschke R, Wolff A, Frenzel C, Eickhoff A, Schulze J. Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders. World J Gastroenterol. 2015 Apr 21; 21(15): 4466-90. [DOI: 10.3748/wjg.v21.i15.4466]. Review. [PMID: 25914456]; [PMCID: PMC4402294].

128. Riehl ME. The Emerging Role of Brain-Gut Therapies for Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2018 Jul; 14(7): 436-438. [PMID: 30166961]; [PMCID: PMC6111498].

129. Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychol Res Behav Manag. 2017 Jul 19; 10: 231-237. [DOI: 10.2147/PRBM.S120817]. eCollection 2017. Review. [PMID: 28790872]; [PMCID: PMC5530860].

130. Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, Whorwell PJ, de Wit NJ. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2019 Jan; 4(1): 20-31. [DOI: 10.1016/S2468-1253(18)30310-8]. Epub 2018 Nov 23. [PMID: 30473202].

131. Hasan SS, Pearson JS, Morris J, Whorwell PJ. SKYPE HYPNOTHERAPY FOR IRRITABLE BOWEL SYNDROME: Effectiveness and Comparison with Face-to-Face Treatment. Int J Clin Exp Hypn. 2019 Jan-Mar; 67(1): 69-80. [DOI: 10.1080/00207144.2019.1553766]; [PMID: 30702396]; [PMCID: PMC6538308].

132. Vasant DH, Whorwell PJ. Gut-focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence-base, practical aspects, and the Manchester Protocol. Neurogastroenterol Motil. 2019 Aug; 31(8): 1-12. [DOI: 10.1111/nmo.13573]. Epub 2019 Feb 27. Review. [PMID: 30815936].

133. Lee HH, Choi YY, Choi MG. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2014 Apr 30; 20(2): 152-62. [DOI: 10.5056/jnm.2014.20.2.152]. Review. [PMID: 24840368]; [PMCID: PMC4015203].

134. Peter J, Fournier C, Keip B, Rittershaus N, Stephanou-Rieser N, Durdevic M, Dejaco C, Michalski M, Moser G. Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy. Int J Mol Sci. 2018 Nov 16; 19(11). pii: E3619. [DOI: 10.3390/ijms19113619]; [PMID: 30453528]; [PMCID: PMC6274728].

135. Kawanishi H, Sekiguchi A, Funaba M, Fujii Y, Yoshiuchi K, Kikuchi H, Kawai K, Maruo K, Sugawara N, Hatano K, Shoji T, Yamazaki T, Toda K, Murakami M, Shoji M, Ohara C, Tomita Y, Fukudo S, Ando T. Cognitive behavioral therapy with interoceptive exposure and complementary video materials for irritable bowel syndrome (IBS): protocol for a multicenter randomized controlled trial in Japan. Biopsychosoc Med. 2019 Jun 6; 13: 14. [DOI: 10.1186/s13030-019-0155-2]. eCollection 2019. [PMID: 31178921]; [PMCID: PMC6551860].

136. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, Hamilton FA, Katz LA, Krasner SS, Ma CX, Radziwon CD, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology. 2018 Jul; 155(1): 47-57. Epub 2018 Apr 25. Erratum in: Gastroenterology. 2018 Oct; 155(4): 1281. [PMID: 29702118]; [PMCID: PMC6035059].

137. Lackner JM, Jaccard J, Radziwon CD, Firth RS, Gudleski GD, Hamilton F, Katz LA, Keefer L, Krasner SS, Ma CX, Sitrin MD, Brenner DM. Durability and Decay of Treatment Benefit of Cognitive Behavioral Therapy for Irritable Bowel Syndrome: 12-Month Follow-Up. Am J Gastroenterol. 2019 Feb; 114(2): 330-338. [DOI: 10.1038/s41395-018-0396-x]; [PMID: 30429592].

138. Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop F, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R; ACTIB trial group. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut. 2019 Sep; 68(9): 1613-1623. [DOI: 10.1136/gutjnl-2018-317805]. Epub 2019 Apr 10. [PMID: 30971419].

139. Radu M, Moldovan R, Pintea S, Băban A, Dumitrascu D. Predictors of outcome in cognitive and behavioural interventions for irritable bowel syndrome. A meta-analysis. J Gastrointestin Liver Dis. 2018 Sep; 27(3): 257-263. [DOI: 10.15403/jgld.2014.1121.273.bab]. Review. [PMID: 30240469].

140. Zhou C, Zhao E, Li Y, Jia Y, Li F. Exercise therapy of patients with irritable bowel syndrome: A systematic review of randomized controlled trials. Neurogastroenterol Motil. 2019 Feb; 31(2): e13461. [DOI: 10.1111/nmo.13461]. Epub 2018 Sep 19. Review. [PMID: 30232834].

141. Evans S, Seidman LC, Lung K, Sternlieb B, Zeltzer LK. Yoga for Teens With Irritable Bowel Syndrome: Results From a Mixed-Methods Pilot Study. Holist Nurs Pract. 2018 Sep/Oct; 32(5): 253-260. [DOI: 10.1097/HNP.0000000000000288]; [PMID: 30113959]; [PMCID: PMC6283406].

142. Evans S, Lung KC, Seidman LC, Sternlieb B, Zeltzer LK, Tsao JC. Iyengar yoga for adolescents and young adults with irritable bowel syndrome. J Pediatr Gastroenterol Nutr. 2014 Aug; 59(2): 244-53. [DOI: 10.1097/MPG.0000000000000366]; [PMID: 25025601]; [PMCID: PMC4146428].

143. Patel N, Lacy B. Does Yoga Help Patients With Irritable Bowel Syndrome? Clinical Gastroenterology and Hepatology 2016; 14: 1732-1734. [DOI: 10.1016/j.cgh.2016.08.014]. Available from: https://www.cghjournal.org/article/S1542-3565(16)30555-9/pdf

144. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014 Sep 2; 14: 328. [DOI: 10.1186/1472-6882-14-328]. Review. [PMID: 25183419]; [PMCID: PMC4161862].

145. Schumann D, Langhorst J, Dobos G, Cramer H. Randomised clinical trial: yoga vs a low-FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2018 Jan; 47(2): 203-211. [DOI: 10.1111/apt.14400]. Epub 2017 Oct 27. [PMID: 29076171].

146. Reddel S, Putignani L, Del Chierico F. The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients. 2019 Feb 12; 11(2). pii: E373. [DOI: 10.3390/nu11020373]. Review. PubMed PMID: 30759766]; [PMCID: PMC6413021].

147. Staudacher HM, Ralph FSE, Irving PM, Whelan K, Lomer MCE. Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet. J Acad Nutr Diet. 2019 Apr 24. pii: S2212-2672(18)31829-X. [DOI: 10.1016/j.jand.2019.01.017]. Epub ahead of print. [PMID: 31029650].

148. Kortlever TL, Ten Bokkel Huinink S, Offereins M, Hebblethwaite C, O'Brien L, Leeper J, Mulder CJJ, Barrett JS, Gearry RB. Low-FODMAP Diet Is Associated With Improved Quality of Life in IBS Patients-A Prospective Observational Study. Nutr Clin Pract. 2019 Aug; 34(4): 623-630. [DOI: 10.1002/ncp.10233]. Epub 2019 Jan 15. [PMID: 30644587].

149. Eswaran S, Dolan RD, Ball SC, Jackson K, Chey W. The Impact of a 4-Week Low-FODMAP and mNICE Diet on Nutrient Intake in a Sample of US Adults with Irritable Bowel Syndrome with Diarrhea. J Acad Nutr Diet. 2019 May 15. pii: S2212-2672(18)31544-2. [DOI: 10.1016/j.jand.2019.03.003]. Epub ahead of print. [PMID: 31103370].

150. Mari A, Hosadurg D, Martin L, Zarate-Lopez N, Passananti V, Emmanuel A. Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link? Eur J Gastroenterol Hepatol. 2019 Feb; 31(2): 178-182. [DOI: 10.1097/MEG.0000000000001317]; [PMID: 30543574].

151. Mitchell H, Porter J, Gibson PR, Barrett J, Garg M. Review article: implementation of a diet low in FODMAPs for patients with irritable bowel syndrome-directions for future research. Aliment Pharmacol Ther. 2019 Jan; 49(2): 124-139. [DOI: 10.1111/apt.15079]. Review. [PMID: 30589971].

152. Ooi SL, Correa D, Pak SC. Probiotics, prebiotics, and low FODMAP diet for irritable bowel syndrome - What is the current evidence? Complement Ther Med. 2019 Apr; 43: 73-80. [DOI: 10.1016/j.ctim.2019.01.010]. Epub 2019 Jan 16. [PMID: 30935559].

153. National Collaborating Centre for Nursing and Supportive Care (UK). Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]. London: Royal College of Nursing (UK); 2008 Feb. (NICE Clinical Guidelines, No. 61.) 7, Diet and lifestyle. Available from: https://www.ncbi.nlm.nih.gov/books/NBK51960/

154. Jankovich, E., and S. Watkins. "The Low FODMAP Diet Reduced Symptoms in a Patient With Endometriosis and IBS". South African Journal of Clinical Nutrition, Vol. 30, no. 4, Dec. 2017, pp. 32-36, http://www.sajcn.co.za/index.php/SAJCN/article/view/1301.

155. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). Int J Mol Med. 2017 Sep; 40(3): 607-613. [DOI: 10.3892/ijmm.2017.3072]. Epub 2017 Jul 19. [PMID: 28731144]; [PMCID: PMC5548066].


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