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Table 2 Characteristics of randomised controlled trials of moxibustion vs. sham or other treatments for irritable bowel syndrome

From: Moxibustion in the management of irritable bowel syndrome: systematic review and meta-analysis

Study (year) Country Sample size (% female) Diagnostic criteria used for IBS Type of IBS (based on the predominant stool form) Criteria used to define symptom improvement Moxa intervention (duration)* Control intervention (duration) Risk of bias assessmenta
Moxa/AT vs. sham moxa/AT
Anastasi (2009) USA [18] 29 (66%) Rome III and negative GI investigations Unspecified Changes in CGIS Moxa and AT (4 weeks): Indirect and individualised, twice weekly Sham moxa and sham AT (4 weeks): Superficial needling at non-acupoints/moxa above and away from acupoints U-U-Y-Y-U-Y
Moxa/AT vs. pharmacological medications
Chen (2011) China [19] 59 (53%) Rome III, negative GI investigations and TCM criteria D 100% ≥ 30% improvement in global IBS symptoms Moxa and AT (3 weeks): Indirect and partially individualised, o.d., 5 sessions/course, 3 courses in total Medication (3 weeks): Y-Y-N-N-Y-Y
- Smecta 1 bag/time b.d.
- Loperamide 4 mg/time t.i.d. and pinaverium bromide 50 mg/time t.i.d. if diarrhea did not stop
Zeng (2010) China [35] 65 (58%) Rome III D 100% ≥ 50% improvement in global IBS symptoms Moxa and AT (1 month): Indirect and partially individualized, o.d., 10 sessions/course in dog days Medication (1 month): Trimebutine maleate 100 mg/time, t.i.d. Y-Y-N-N-Y-Y
Xue (2009) China [34] 200 (51%) Rome II and TCM criteria Unspecified Any improvement in global IBS symptoms Moxa and AT (23–49 days): Fixed, o.d. for 10 sessions (1 course), 2–4 courses in total, with 3 days of no TX interval Medication (23–49 days): Sulfasalazine 10 mg/kg, o.d. for 10 days (1 course), 2–4 courses in total U-U-N-N-Y-Y
Wang (2008) China [31] 110 (unspecified) Rome II D 100% ≥ 30% improvement in global IBS symptoms Warming needle (23 days): Fixed, o.d. for 10 sessions (1 course), 2 courses in total, with 3 days of no TX interval Medication (23 days): Smecta, 1 bag/time t.i.d. U-U-N-N-Y-Y
Moxa plus other treatments vs. other treatments
Hu (2012) China [21] 64 (22%) Rome III, negative GI investigations and TCM criteria D 100% ≥ 30% improvement in global IBS symptoms Moxa and AT (8 weeks): AT (8 weeks): Partially individualized, o.d., 5 sessions/week, 20 sessions/course, 2 courses in total Y-U-N-N-Y-Y
- Moxa: indirect and partially individualized, o.d., 5
sessions/week, 20 sessions/course, 2 courses in total
- AT: partially individualized, o.d., 5 sessions/week, 20 sessions/course, 2 courses in total
Shang (2012) China [29] 48 (58%) Rome II and negative GI investigations D 100% Any improvement in global IBS symptoms Moxa/AT and medication (30 days): Indirect and fixed, o.d., 10 sessions/course, 3 courses in total Medication and dietary advice (30 days): U-U-N-N-Y-Y
- GI antispasmodic drugs, antidiarrheal drugs, anti-anxiety drugs, and intestinal flora regulating drugs
Jiang (2010) China [23] 60 (57%) Rome II and negative GI investigations D 100% Any improvement in global IBS symptoms Moxa and medication (4 weeks): Medication (4 weeks): Trimebutine 0.2 g/time, t.i.d. U-U-N-N-U-N
- Moxa: ginger-partitioned and fixed, o.d. for 7 sessions (1 course), 4 courses in total, with 1 day of no TX interval
- Medication: Trimebutine 0.2 g/time, t.i.d.
Wang (2009) China [30] 60 (55%) Rome II and TCM criteria (liver-qi stagnation with spleen deficiency type) D 100% Any improvement in global IBS symptoms Moxa and herbal medicine (1 month): Herbal medicine (1 month): Partially individualised U-U-N-N-Y-Y
- Moxa: indirect and fixed, o.d.
- Herbal medicine: partially individualised
Xiong (2008) China [33] 120 (60%) Rome II, negative GI investigations and TCM criteria (liver-qi stagnation with spleen deficiency type) D 100% ≥ 30% improvement in global IBS symptoms AT/warming needle and herbal medicine (4 weeks): Herbal medicine (4 weeks): Fixed, b.d. U-U-N-N-Y-Y
- AT/warming needle: fixed, no information on sessions
- Herbal medicine: fixed, b.d.
Huang (2007) China [22] 61 (unspecified) Rome III, negative GI investigations and TCM criteria Unspecified Any improvement in global IBS symptoms Moxa and colon hydrotherapy (4 weeks): Colon hydrotherapy (4 weeks): Twice weekly for constipation, once weekly for diarrhea U-U-N-N-Y-Y
- Indirect and partially individualized, o.d.
- Colon hydrotherapy: twice weekly for constipation, once weekly for diarrhea
Liu (1997) [24] China 150 (41%) Only stated that “all participants had IBS and no organic GI disease” Unspecified Any improvement in global IBS symptoms AT/moxa and psychotherapy (10–75 days): Individualised AT followed by indirect and fixed moxa, once every other day for 10 sessions (1 course), 1–6 courses, with 3–5 days of no TX interval Psychotherapy (7–42 days): 1–2 sessions/week (1 course), 1–6 courses, each session performed ahead of AT Y-U-N-N-N-Y
Moxa/AT vs. probiotics
An (2010) China [17] 81 (62%) Rome II Unspecified ≥ 30% improvement in global IBS symptoms Moxa and AT (4 weeks): Indirect and fixed, o.d. for 12 sessions (1 course), 2 courses in total, with 3 days of no TX interval Bifid triple viable capsules (4 weeks): Bifidobacterium longum, Lactobacillus acidophillus, and Enterococcus faecalis 420 mg (2 capsules)/time, t.i.d. Y-U-N-N-Y-Y
  1. aRisk of bias was evaluated for 6 criteria in order [11], i.e. sequence generation, allocation concealment, blinding of participants, blinding of outcome assessors, incomplete outcome data, and selective outcome reporting. Each criterion was scored as yes (Y), no (N), or unclear (U), where Y indicates a low risk of bias, N indicates a high risk of bias and U indicates an unclear risk of bias.
  2. *Moxibustion method was classified into three categories on the basis of the levels of individualisation: “fixed” means all patients receive the same treatment at all sessions, “partially individualised” means using a fixed set of points to be combined with a set of points to be used flexibly, and “individualised” means each patient receives a unique and evolving diagnosis and treatment [38].
  3. AT, acupuncture; b.d., twice a day; CGIS, 7-point Likert-type Clinical Global Impression Scale; D, diarrhea-predominant subtype of IBS; GI, gastrointestinal; GP, general practitioner; IBS, irritable bowel syndrome; moxa, moxibustion; o.d., once a day; SSS, severity scoring system; TCM, traditional Chinese medicine; t.i.d., three times a day; TX, treatment.