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Meta-Analysis
. 2024 Mar 23;16(7):934.
doi: 10.3390/nu16070934.

Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Preetha Iyengar  1 , Gala Godoy-Brewer  2 , Isha Maniyar  3 , Jacob White  4 , Laura Maas  5 , Alyssa M Parian  6 , Berkeley Limketkai  3
Affiliations
Meta-Analysis

Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Preetha Iyengar et al. Nutrients. .

Abstract

Herbal medicines are used by patients with IBD despite limited evidence. We present a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating treatment with herbal medicines in active ulcerative colitis (UC). A search query designed by a library informationist was used to identify potential articles for inclusion. Articles were screened and data were extracted by at least two investigators. Outcomes of interest included clinical response, clinical remission, endoscopic response, endoscopic remission, and safety. We identified 28 RCTs for 18 herbs. In pooled analyses, when compared with placebo, clinical response rates were significantly higher for Indigo naturalis (IN) (RR 3.70, 95% CI 1.97-6.95), but not for Curcuma longa (CL) (RR 1.60, 95% CI 0.99-2.58) or Andrographis paniculata (AP) (RR 0.95, 95% CI 0.71-1.26). There was a significantly higher rate of clinical remission for CL (RR 2.58, 95% CI 1.18-5.63), but not for AP (RR 1.31, 95% CI 0.86-2.01). Higher rates of endoscopic response (RR 1.56, 95% CI 1.08-2.26) and remission (RR 19.37, 95% CI 2.71-138.42) were significant for CL. CL has evidence supporting its use as an adjuvant therapy in active UC. Research with larger scale and well-designed RCTs, manufacturing regulations, and education are needed.

Keywords: complementary therapies; dietary supplements; herbal medicines; integrative medicine; phytotherapy; plant extracts; ulcerative colitis.

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Conflict of interest statement

B.L. is a consultant of Azora Therapeutics. The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Meta-analyses with Forest plots of Curcuma longa for (a) clinical response, (b) clinical remission, (c) endoscopic response, and (d) endoscopic remission. CI = confidence interval. Certainty of evidence was downgraded for 1 risk of bias, 2 imprecision, 3 inconsistency, 4 indirectness, and 5 publication bias. CI = confidence interval.
Figure 3
Figure 3
Meta-analyses with Forest plot of clinical response in Indigo naturalis. Certainty of evidence was downgraded for 1 risk of bias, 2 imprecision, 3 inconsistency, 4 indirectness, and 5 publication bias. CI = confidence interval.
Figure 4
Figure 4
Meta-analyses and Forest plots of (a) clinical response, (b) clinical remission, and (c) endoscopic response in Andrographis paniculata. Certainty of evidence was downgraded for 1 risk of bias, 2 imprecision, 3 inconsistency, 4 indirectness, and 5 publication bias. CI = confidence interval.
See this image and copyright information in PMC

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