Systematic Review

The Efficacy of Herbal Therapy in Inflammatory Bowel Disease

S. C. Ng; Y. T. Lam; K. K. F. Tsoi; F. K. L. Chan; J. J. Y. Sung; J. C. Y. Wu

Disclosures

Aliment Pharmacol Ther. 2013;38(8):854-863. 

In This Article

Abstract and Introduction

Abstract

Background Complementary and alternative medicine (CAM), particularly herbal therapy, is widely used by patients with inflammatory bowel disease (IBD) but controlled data are limited.

Aim To systematically review the literature on the efficacy of herbal therapy in the treatment of ulcerative colitis (UC) and Crohn's disease (CD).

Methods Publications in English and non-English literatures (MEDLINE, EMBASE, EBM Reviews, AMED, Global Health) were searched from 1947 to 2013 for controlled clinical studies of herbal therapy in IBD. Outcome measures included response and remission rates.

Results Twenty-one randomised controlled trials (14 UC; 7 CD) including a total of 1484 subjects (mean age 41, 50% female) were analysed. In UC, aloe vera gel, Triticum aestivum (wheat grass juice), Andrographis paniculata extract (HMPL-004) and topical Xilei-san were superior to placebo in inducing remission or response, and curcumin was superior to placebo in maintaining remission; Boswellia serrata gum resin and Plantago ovata seeds were as effective as mesalazine, whereas Oenothera biennis (evening primrose oil) had similar relapse rates as omega-3 fatty acids in the treatment of UC. In CD,Artemisia absinthium (wormwood) and Tripterygium wilfordii were superior to placebo in inducing remission, and preventing clinical recurrence of post-operative CD respectively.

Conclusions Randomised controlled trials of herbal therapy for the treatment of IBD show encouraging results but studies remain limited and heterogenous. Larger controlled studies with stricter endpoints and better-defined patient groups are required to obtain more conclusive results on the use of CAM therapies in IBD.

Introduction

Crohn's disease (CD) and ulcerative colitis (UC) are chronic idiopathic inflammatory bowel disorders (IBD) in which patients often require lifelong medication. Poor adherence to medication has been an important barrier to successful management. Understanding patients' beliefs and concerns and addressing physical and perceptual barriers to adherence is crucial in improving adherence.[1] The conventional treatment for IBD involves the use of corticosteroids, immunosuppressants and antitumour necrosis factor (TNF) antibodies. Some of these agents have been associated with the risks of infection and malignancy.[2,3]

In recent years, complementary and alternative medicine (CAM) is increasingly being used by patients with IBD because of its perceived natural and healthy properties. Population-based and cohort studies have shown that the use of CAM is common among adult and paediatric IBD patients.[4–11] The prevalence of current or past CAM use in adult IBD populations from North America and Europe ranges from 21% to 60%.[5] In a comparative study of Chinese and Caucasian patients, the overall use of CAM was similar in both groups and similar for CD and UC.[12] Younger age, female gender, a higher education level, adverse drug reactions from IBD medication,[7,8] extra-intestinal manifestations,[4] perceived stress[13] and prolonged and intensive courses of steroids[14] have been associated with the use of CAM in IBD.

CAM products that have been evaluated in clinical studies for the treatment of IBD include herbal medicine, dietary supplementation (probiotics, prebiotics or fish oil), and mind body medicines such as acupuncture, moxibustion or hypnotherapy.[5] Although research has explored many of these products, scientific evidence regarding their efficacy or safety has not been adequate, and the majority of studies have produced inconsistent results.

The aim of this systematic review is to evaluate the efficacy of herbal therapy in the treatment of IBD. We investigated the use of herbal therapy for both the induction and maintenance of disease remission in UC and CD.

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