title: Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) is a common and often lifelong functional gastrointestinal disorder. There is a scarcity of effective management options for IBS.
  
  
  OBJECTIVE
  To assess the effectiveness of osteopathic manipulative therapy (OMTh) for managing the symptoms of IBS.
  
  
  METHODS
  Articles without language or publication-date restriction were searched in PubMed, Embase, Cochrane Library, PEDro, OSTMED.DR, and Osteopathic Research Web. Search terms included irritable bowel syndrome, IBS, functional colonic disease, colon irritable, osteopath*, osteopathic manipulation, osteopathic medicine, clinical trial, and randomized clinical trial. Experts in the field of visceral osteopathy were also contacted to identify additional studies.
  
  
  METHODS
  The authors evaluated randomized controlled trials (RCTs) of OMTh for IBS in adults in whom IBS was diagnosed using Rome (I-III) criteria. If OMTh was not the sole intervention in the intervention group and if the same additional interventions were not applied to the control group, the study was excluded.
  
  
  METHODS
  Citation identification, study selection, and data extraction were independently undertaken by 2 reviewers with a data extraction form from the Cochrane Collaboration. A consensus method was used to resolve disagreements concerning the assessment of the methodologic quality of the RCTs that were reviewed.
  
  
  RESULTS
  The search identified 10 studies that examined OMTh for patients with IBS; 5 studies (204 patients) met the inclusion criteria. All studies were assessed as having low risk of bias according to the Cochrane Collaboration criteria, although there was heterogeneity in the outcome measures and control interventions. Three studies used visual analog scales for abdominal pain, whereas others used the IBS severity score and the Functional Bowel Disorder Severity Index. A variety of secondary outcomes were used. All studies reported more pronounced short-term improvements with OMTh compared with sham therapy or standard care only. These differences remained statistically significant after variable lengths of follow-up in 3 studies.
  
  
  CONCLUSIONS
  The present systematic review provides preliminary evidence that OMTh may be beneficial in the treatment of patients with IBS. However, caution is required in the interpretation of these findings because of the limited number of studies available and the small sample sizes.
authors.affiliation: From the Institute for Osteopathic Studies in Siegen, Germany (Mr Müller and Mr Franke); the University of Dresden and German Institute for Health Research (Dr Resch); and the College of Health and Biomedicine and the Institute of Sport, Exercise and Active Living at Victoria University in Melbourne, Australia (Dr Fryer).
authors.forename: Axel
authors.initials: A
authors.lastname: Müller
authors.affiliation: From the Institute for Osteopathic Studies in Siegen, Germany (Mr Müller and Mr Franke); the University of Dresden and German Institute for Health Research (Dr Resch); and the College of Health and Biomedicine and the Institute of Sport, Exercise and Active Living at Victoria University in Melbourne, Australia (Dr Fryer).
authors.forename: Helge
authors.initials: H
authors.lastname: Franke
authors.affiliation: From the Institute for Osteopathic Studies in Siegen, Germany (Mr Müller and Mr Franke); the University of Dresden and German Institute for Health Research (Dr Resch); and the College of Health and Biomedicine and the Institute of Sport, Exercise and Active Living at Victoria University in Melbourne, Australia (Dr Fryer).
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Resch
authors.affiliation: From the Institute for Osteopathic Studies in Siegen, Germany (Mr Müller and Mr Franke); the University of Dresden and German Institute for Health Research (Dr Resch); and the College of Health and Biomedicine and the Institute of Sport, Exercise and Active Living at Victoria University in Melbourne, Australia (Dr Fryer) gary.fryer@vu.edu.au.
authors.forename: Gary
authors.initials: G
authors.lastname: Fryer
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000628:therapy*; D026301:Manipulation, Osteopathic / Q000379:methods*