Irritable bowel syndrome (IBS) is a common chronic disorder characterised by altered bowel habits and abdominal pain, discomfort, bloating, constipation or diarrhoea or both. It is difficult to treat because no single cause has been identified. IBS impairs health-related quality of life and work productivity. Currently there is no agreement on the best form of treatment for IBS. Therefore it is important to evaluate the effectiveness and safety of treatments, including homeopathic treatment, which some IBS sufferers use. Clinical homeopathy matches a 'remedy' to a specific condition (such as arnica for bruising), whereas individualised homeopathy involves a series of in-depth consultations to assess symptoms, the effects of remedies and other issues that may affect the patient, in order to select appropriate 'remedies'. Individualised homeopathy includes both a consultation and a remedy, whereas clinical homeopathy consists of a remedy without the in-depth consultation.
This review identified three randomised controlled trials (RCTs) including a total of 213 participants. Two RCTs (129 participants) compared a homeopathic remedy to a placebo remedy for the treatment of constipation-predominant IBS. The other study (23 participants) compared individualised homeopathic treatment (consultation plus remedy) to usual care in female patients diagnosed with IBS. Usual care consisted of high doses of dicyclomine hydrochloride (an antispasmodic drug) and faecal bulking agents (e.g. foods high in fibre). Patients in the usual care group received diet sheets asking them to take a high fibre diet. The three trials tested the effects of homeopathic treatment on the severity of IBS symptoms. None of the included studies reported on side effects. The RCT comparing individualised homeopathic treatment to usual care found no statistically significant difference between homeopathic treatment and usual care. No conclusions can be drawn from this study due to the small number of participants and the low quality of reporting in this trial. In addition, this study was carried out in 1990 and usual care for IBS may have changed since then. Therefore it is not known how individualized homeopathic treatment performs when compared with current usual care. A pooled analysis of two small studies (129 participants) suggests a possible benefit for clinical homeopathy, using the remedy asafoetida, over placebo for people with constipation-predominant IBS at a short-term follow-up of two weeks. However both of the studies were carried out in the 1970s when the reporting of trials was not as comprehensive as it is now. These studies were subject to bias which makes it difficult to determine whether the benefit found in these studies are a true reflection of the effectiveness of homeopathic treatment. Further high quality RCTs enrolling larger numbers of patients are required to assess the effectiveness and safety of clinical and individualised homeopathy compared to placebo or usual care.