![]() Forrest Plots of Meta-analysis of Enteric-Coated Peppermint Oil for the treatment of Irritable Bowel Syndrome. Figure 2b shows the overall risk of bias by domain: the risk of bias is displayed as low risk (green, +), unclear (yellow,?), or high risk (red, −)Ī- c. Selective reporting was not observed in any studies (low risk if bias). In contrast, the blinding of participants and personnel were well performed (low risk of performance bias in seven of the 12 included studies). Ten of the 12 included studies did not report random sequence generation and allocation concealment (unclear risk of selection bias). Six of the 12 studies were assessed as having high risk of attrition bias and two studies were funded by industry (high risk of bias). ,, denote low, unclear, and high risk of bias, respectively. Seven domains of risk of bias were assessed for each study, including random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and industry funded. ![]() Studies were indexed by the last name of the first author and year of publication. a illustrates the risk of bias for each study. The included studies were evaluated for methodological flaws using the Cochrane Collaboration’s risk of bias assessment tool. Risk of Bias Assessment Using Cochrane the Collaboration’s Tool. Ten articles were eliminated, thus leaving twelve for qualitative and data synthesisĪ- b. After de-duplication, 427 records were screened and 22 deemed suitable for full-text review. Seven hundred and fifty-nine articles were identified using PubMed ( n = 102)/EMBASE ( n = 396)/Cochrane ( n = 60)/Web of Science ( n = 201) search engines. A detailed evaluation of the articles by at least two independent reviewers (total of three) assessed the sufficiency of data and relevance to the topic. ![]() Non-randomized trials observational studies such as cohort study, cross-sectional study, etc. Exclusion: Patients having an organic disease or who had not had an organic disease were excluded. Inclusion: Adult patients (18 years or greater) with IBS as diagnosed using any of the following criteria for IBS: Manning Criteria, Rome I, II, III, IV diagnostic criteria who were randomized to enteric-coated peppermint oil or placebo for a minimum of two weeks. PRISMA flowchart illustrating the process for the selection of the included articles for the systematic review and for the data synthesis of the randomized controlled clinical trials of enteric-coated peppermint oil versus placebo in patients with irritable bowel syndrome (IBS). In the most comprehensive meta-analysis to date, PO was shown to be a safe and effective therapy for pain and global symptoms in adults with IBS.Ībdominal pain Global symptom relief IBS Irritable bowel syndrome Meta-analysis PRISMA Peppermint oil. The number needed to treat with PO to prevent one patient from having persistent symptoms was three for global symptoms and four for abdominal pain. Overall, there were no differences in the reported adverse effects: PO (32 events, 344 total, 9.3%) versus placebo (20 events, 327 total, 6.1%) for eight RCTs RR 1.40 I 2 = 0%, z = 1.39 (p = 0.16). ![]() Regarding abdominal pain, the RR from six RCTs for the effect of PO (n = 278) versus placebo (n = 278) was 1.78, I 2 = 0%, z = 5.23 (p < 0.00001). For global symptom improvement, the risk ratio (RR) from seven RCTs for the effect of PO (n = 253) versus placebo (n = 254) on global symptoms was 2.39, I 2 = 0%, z = 7.93 (p < 0.00001). Twelve randomized trials with 835 patients were included. A PRISMA-compliant study protocol is registered in PROSPERO Register. We performed random-effects meta-analysis on primary outcomes including global improvement in IBS symptoms and abdominal pain. We appraised the eligible studies by the Cochrane risk of bias tool. We systematically searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane CENTRAL),, EMBASE (Ovid), and Web of Science for randomized controlled trials (RCTs) of PO for IBS. The study objective was to determine the effect of peppermint oil in the treatment of the IBS. Peppermint oil (PO) has intrinsic properties that may benefit patients with irritable bowel syndrome (IBS) symptoms. ![]()
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