The Potential of Complementary and Alternative Therapies in Improving Diarrhea-Predominant Irritable Bowel Syndrome: Strategies for Long-Term Efficacy: GI Signals

Motility systematic review · Aug 12, 2026 · Dig Dis Sci · IF 2.5

The Potential of Complementary and Alternative Therapies in Improving Diarrhea-Predominant Irritable Bowel Syndrome: Strategies for Long-Term Efficacy.

Basic scienceIBSmicrobiomediet therapy

Clinical takeawayReview proposes mechanisms for CAM in IBS-D without specific protocols or comparative efficacy data. Dietary modification is already standard adjunct; TCM or acupuncture may be discussed with refractory patients based on mechanistic plausibility and preference.

What it foundReview synthesizes literature on traditional Chinese medicine, acupuncture, and dietary interventions for IBS-D, proposing multi-target mechanisms (gut microbiota modulation, intestinal barrier restoration, visceral hypersensitivity reduction, gut-brain axis regulation) that may provide sustained symptom relief, but reports no quantified efficacy data or comparison to standard therapy.

ContextStandard IBS-D management includes dietary modification, antidiarrheals, antispasmodics, and agents such as linaclotide or alosetron. This review proposes CAM approaches as adjunctive strategies via multiple mechanistic pathways but does not establish comparative outcomes or when to preferentially use them.

Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021

Decision at stakewhether to recommend complementary and alternative therapies (traditional Chinese medicine, acupuncture) as adjuncts in IBS-D management

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

Diagnosis: use a positive diagnostic strategy based on Rome IV criteria rather than a strategy of exclusion (strong for cost-effectiveness, high quality; consensus for time-to-therapy), and categorize by IBS subtype (consensus). In patients with IBS and diarrhea symptoms: check celiac serology (strong, moderate) and, in those WITHOUT alarm features, fecal calprotectin (or fecal lactoferrin) plus CRP to rule out IBD (strong; moderate quality for CRP/calprotectin, very low for lactoferrin). Recommend AGAINST routine stool testing for enteric pathogens (conditional, low) and AGAINST routine colonoscopy in patients younger than 45 without warning signs (conditional, low). Anorectal physiology testing only when symptoms suggest a pelvic floor disorder and/or for refractory constipation not responding to standard medical therapy (consensus). Treatment, all subtypes: soluble, not insoluble, fiber (strong, moderate); a LIMITED trial of a low-FODMAP diet (conditional, very low); gut-directed psychotherapies for global symptoms (conditional, very low); TCAs for global symptoms (strong, moderate); peppermint suggested (conditional, low); antispasmodics for abdominal pain (conditional, low); AGAINST probiotics (conditional, very low), AGAINST fecal transplant (strong, very low). IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). IBS-D: rifaximin (strong, moderate); alosetron only for women with severe IBS-D who have failed conventional therapy (conditional, low); mixed opioid agonists/antagonists, i.e. eluxadoline (conditional, moderate); AGAINST bile acid sequestrants (conditional, very low).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021 · reviewed 2026-07-21 ↗

Deng Y … Chen S · Digestive Diseases and Sciences · IF 2.5 · PubMed ↗Permalink