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Effect of Yoga in the Therapy of Irritable Bowel Syndrome: A Systematic Review

  • Dania Schumann
    Correspondence
    Reprint requests Address requests for reprints to: Dania Schumann, MSc, Kliniken Essen-Mitte, Klinik für Naturheilkunde und Integrative Medizin, Knappschafts-Krankenhaus, Am Deimelsberg 34a, 45276 Essen, Germany. fax: +49201 174 25000.
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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  • Dennis Anheyer
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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  • Romy Lauche
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

    Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia
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  • Gustav Dobos
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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  • Jost Langhorst
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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  • Holger Cramer
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

    Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia
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Published:April 22, 2016DOI:https://doi.org/10.1016/j.cgh.2016.04.026

      Background & Aims

      This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS.

      Methods

      MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations.

      Results

      Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear.

      Conclusions

      The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS. ClinicalTrials.gov number, NCT02721836.

      Keywords

      Abbreviations used in this paper:

      GI (gastrointestinal), IBS (irritable bowel syndrome), MBSR (mindfulness-based stress reduction), NRS (Numeric Rating Scale), RCT (randomized controlled trial)
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      References

        • Drossman D.A.
        Rome III: the new criteria.
        Chin J Dig Dis. 2006; 7: 181-185
        • Drossman D.A.
        • Dumitrascu D.L.
        Rome III: new standard for functional gastrointestinal disorders.
        J Gastrointestin Liver Dis. 2006; 15: 237-241
        • Musial F.
        • Enck P.
        Irritables darmsyndrom (IBS).
        in: Caspary W.F. Stein J. Darmkrankheiten: Klinik, Diagnostik und Therapie. Springer, Berlin1999: 525-530
        • Musial F.
        • Choi K.
        • Enck P.
        Gastroenterologische Erkrankungen.
        in: Bengel J. Jerusalem M. Handbuch der gesundheitspsychologie und medizinischen psychologie. Hogrefe, Göttingen2009: 459-467
        • Choi K.
        • Musial F.
        • Langhorst J.
        • et al.
        Ein methodenkritischer Überblick zu Placeboeffekten unter besonderer Berücksichtigung von gastrointestinalen Erkrankungen.
        Z Med Psychol. 2010; 19: 128-136
        • Feuerstein G.
        The yoga tradition.
        Hohm Press, Prescott1998
        • De Michaelis E.
        A history of modern yoga.
        Continuum, London2005
        • Iyengar B.K.S.
        Light on yoga.
        Thorsons, London2001
        • Musial F.
        • Enck P.
        Gastrointestinale Funktionsstörungen.
        in: Ehlert U. Verhaltensmedizin. Springer, Berlin2003: 295-326
        • Salvioli B.
        • Pellegatta G.
        • Malacarne M.
        • et al.
        Autonomic nervous system dysregulation in irritable bowel syndrome.
        Neurogastroenterol Motil. 2015; 27: 423-430
        • North C.S.
        • Hong B.A.
        • Alpers D.H.
        Relationship of functional gastrointestinal disorders and psychiatric disorders: implications for treatment.
        World J Gastroenterol. 2007; 13: 2020-2027
        • Jalanka-Tuovinen J.
        • Salonen A.
        • Nikkila J.
        • et al.
        Intestinal microbiota in healthy adults: temporal analysis reveals individual and common core and relation to intestinal symptoms.
        PLoS One. 2011; 6: e23035
        • Rhee S.H.
        • Pothoulakis C.
        • Mayer E.A.
        Principles and clinical implications of the brain-gut-enteric microbiota axis.
        Nat Rev Gastroenterol Hepatol. 2009; 6: 306-314
        • Mayer E.A.
        Gut feelings: the emerging biology of gut-brain communication.
        Nat Rev Neurosci. 2011; 12: 453-466
        • Cryan J.F.
        • O'Mahony S.M.
        The microbiome-gut-brain axis: from bowel to behavior.
        Neurogastroenterol Motil. 2011; 23: 187-192
        • Tillisch K.
        • Labus J.
        • Kilpatrick L.
        • et al.
        Consumption of fermented milk product with probiotic modulates brain activity.
        Gastroenterology. 2013; 144 (401 e1–4): 1394-1401
        • Streeter C.C.
        • Gerbarg P.L.
        • Saper R.B.
        • et al.
        Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.
        Med Hypotheses. 2012; 78: 571-579
        • Cramer H.
        • Lange S.
        • Klose P.
        • et al.
        Can yoga improve fatigue in breast cancer patients? A systematic review.
        Acta Oncol. 2012; 51: 559-560
        • Cramer H.
        • Lange S.
        • Klose P.
        • et al.
        Yoga for breast cancer patients and survivors: a systematic review and meta-analysis.
        BMC Cancer. 2012; 12: 412
        • Cramer H.
        • Lauche R.
        • Hohmann C.
        • et al.
        Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain.
        Clin J Pain. 2013; 29: 216-223
        • Cramer H.
        • Lauche R.
        • Langhorst J.
        • et al.
        Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials.
        Evid Based Complement Alternat Med. 2012; 2012: 863905
        • Michalsen A.
        • Grossman P.
        • Acil A.
        • et al.
        Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program.
        Med Sci Monit. 2005; 11: CR555-CR561
        • Michalsen A.
        • Jeitler M.
        • Brunnhuber S.
        • et al.
        Iyengar yoga for distressed women: a 3-armed randomized controlled trial.
        Evid Based Complement Alternat Med. 2012; 2012: 408727
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
      1. Higgins JPT, Green S. Cochrane Handbook for systematic reviews of interventions. The Cochrane Collaboration. 2011. Version 5.1.0. Available at: http://www07November2011..cochrane-handbook.org. Accessed October 15, 2015.

        • Baer R.A.
        Mindfulness training as a clinical intervention: a conceptual and empirical review.
        Clin Psychol. 2003; 10: 125-143
        • Francis C.Y.
        • Morris J.
        • Whorwell P.J.
        The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress.
        Aliment Pharmacol Ther. 1997; 11: 395-402
        • Ware J.E.
        • Kosinski M.
        • Dewey J.E.
        How to score version two of the SF-36 Health Survey.
        QualityMetric, Lincoln, RI2000
        • Patrick D.L.
        • Drossman D.A.
        • Frederick I.O.
        • et al.
        Quality of life in persons with irritable bowel syndrome: development and validation of a new measure.
        Dig Dis Sci. 1998; 43: 400-411
        • Walker L.S.
        • Greene J.W.
        The functional disability inventory: measuring a neglected dimension of child health status.
        J Pediatr Psychol. 1991; 16: 39-58
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Lind R.
        • Berstad A.
        • Hatlebakk J.
        • et al.
        Chronic fatigue in patients with unexplained self-reported food hypersensitivity and irritable bowel syndrome: validation of a Norwegian translation of the Fatigue Impact Scale.
        Clin Exp Gastroenterol. 2013; 6: 101-107
        • Evans S.
        • Lung K.C.
        • Seidman L.C.
        • et al.
        Iyengar yoga for adolescents and young adults with irritable bowel syndrome.
        J Pediatr Gastroenterol Nutr. 2014; 59: 244-253
        • Kavuri V.S.
        • Malamud A.
        • Raghuram N.
        • et al.
        Remedial yoga module remarkably improves symptoms in irritable bowel syndrome patients: a 12-week randomized controlled trial.
        European Journal of Integrative Medicine. 2015; 7: 595-608
        • Kuttner L.
        • Chambers C.T.
        • Hardial J.
        • et al.
        A randomized trial of yoga for adolescents with irritable bowel syndrome.
        Pain Res Manag. 2006; 11: 217-223
        • Madhu S.V.
        • Vij J.C.
        • Bhatnagar O.P.
        • et al.
        Colonic myoelectrical activity in irritable bowel syndrome before and after treatment.
        Indian J Gastroenterol. 1988; 7: 31-33
        • Shahabi L.
        • Naliboff B.D.
        • Shapiro D.
        Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study.
        Psychol Health Med. 2015; : 1-13
        • Taneja I.
        • Deepak K.K.
        • Poojary G.
        • et al.
        Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomized control study.
        Appl Psychophysiol Biofeedback. 2004; 29: 19-33
        • Cramer H.
        • Krucoff C.
        • Dobos G.
        Adverse events associated with yoga: a systematic review of published case reports and case series.
        PLoS One. 2013; 8: e75515
        • Crowe M.
        • Jordan J.
        • Burrell B.
        • et al.
        Mindfulness-based stress reduction for long-term physical conditions: a systematic review.
        Aust N Z J Psychiatry. 2015; 50: 21-32
        • Johannesson E.
        • Ringstrom G.
        • Abrahamsson H.
        • et al.
        Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects.
        World J Gastroenterol. 2015; 21: 600-608
        • Johannesson E.
        • Simren M.
        • Strid H.
        • et al.
        Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial.
        Am J Gastroenterol. 2011; 106: 915-922
        • Kavuri V.
        • Raghuram N.
        • Malamud A.
        • et al.
        Irritable bowel syndrome: yoga as remedial therapy.
        Evid Based Complement Alternat Med. 2015; 2015: 398156
        • Kirkwood G.
        • Rampes H.
        • Tuffrey V.
        • et al.
        Yoga for anxiety: a systematic review of the research evidence.
        Br J Sports Med. 2005; 39 (discussion 91): 884-891
        • Kang J.Y.
        Systematic review: the influence of geography and ethnicity in irritable bowel syndrome.
        Aliment Pharmacol Ther. 2005; 21: 663-676
        • Gartlehner G.
        Assessment of adverse effects and applicability: two areas not (yet) covered adequately in Cochrane reports.
        Z Evid Fortbild Qual Gesundhwes. 2008; 102: 497-502
        • Whitehead W.E.
        • Palsson O.
        • Jones K.R.
        Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?.
        Gastroenterology. 2002; 122: 1140-1156
        • Cole J.A.
        • Rothman K.J.
        • Cabral H.J.
        • et al.
        Migraine, fibromyalgia, and depression among people with IBS: a prevalence study.
        BMC Gastroenterol. 2006; 6: 26
        • Mayer E.A.
        • Naliboff B.D.
        • Chang L.
        • et al.
        V. Stress and irritable bowel syndrome.
        Am J Physiol Gastrointest Liver Physiol. 2001; 280: G519-G524
        • Sherman K.J.
        Guidelines for developing yoga interventions for randomized trials.
        Evid Based Complement Alternat Med. 2012; 2012: 16
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.
        Ann Intern Med. 2010; 152: 726-732
        • Bijkerk C.J.
        • de Wit N.J.
        • Muris J.W.
        • et al.
        Outcome measures in irritable bowel syndrome: comparison of psychometric and methodological characteristics.
        Am J Gastroenterol. 2003; 98: 122-127
        • Miller L.E.
        Study design considerations for irritable bowel syndrome clinical trials.
        Ann Gastroenterol. 2014; 27: 338-345
        • Pimentel M.
        • Talley N.J.
        • Quigley E.M.
        • et al.
        Report from the multinational irritable bowel syndrome initiative 2012.
        Gastroenterology. 2013; 144: e1-e5
        • Zernicke K.A.
        • Campbell T.S.
        • Blustein P.K.
        • et al.
        Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial.
        Int J Behav Med. 2013; 20: 385-396
        • Chu I.H.
        • Lin Y.J.
        • Wu W.L.
        • et al.
        Effects of yoga on heart rate variability and mood in women: a randomized controlled trial.
        J Altern Complement Med. 2015;
        • Gaylord S.A.
        • Palsson O.S.
        • Garland E.L.
        • et al.
        Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial.
        Am J Gastroentero. 2011; 106: 1678-1688
      2. Organisation WG. Irritable bowel syndrome: a global perspective. 2009. Available from: http://www.worldgastroenterology.org/guidelines/global-guidelines/irritable-bowel-syndrome-ibs/irritable-bowel-syndrome-ibs-english. Accessed November 3, 2015.