Clinical effects and safety of Compound Glutamine Entersoluble Capsules for diarrhea-predominant irritable bowel syndrome: A systematic review and meta-analysis

Introduction: Diarrhea-predominant irritable bowel syndrome (IBS-D) is a gastrointestinal disease with a high incidence and no effective drugs available. Compound Glutamine Entersoluble Capsules (CGEC) is a compound preparation integrating Sijunzi Decoction and L-Glutamine. The aim of this systematic review was to evaluate the clinical effects and safety of CGEC for IBS-D. Methods: PubMed, Web of Science, the Cochrane library, CNKI, VIP and Wanfang Databases were searched from inception to June 30, 2019. Randomized controlled trials (RCTs) assessing the clinical effects and safety of CGEC for IBS-D were included. Global improvement of IBS-D symptoms was used as the primary outcome. The data were analyzed by RevMan5.3 software. Risk ratio (RR) calculations and 95% confidence intervals (CI) were used for dichotomous outcomes, and mean difference (MD) with 95% CI were used for continuous outcomes. Results: Twelve RCTs involving 1232 participants were included. Compared with western conventional medicine (WCM) alone (i.e. gastrointestinal spasmodic and probiotics), CGEC demonstrated no significant differences in global improvement of IBS-D symptoms (RR 1.09, 95% CI [0.97, 1.23]), reduction in stool frequency (MD 0.14, 95% CI [- 0.18, 0.46]) and relief of abdominal pain (MD 0.12, 95% CI [- 0.27, 0.52]). The combination of CGEC and WCM had advantages over WCM alone in terms of global improvement of IBS-D symptoms (RR 1.37, 95% CI [1.25, 1.49]). Regarding the recurrence rate, both the CGEC group and the combined drug group were lower than the WCM group. In terms of safety, there is currently no evidence to suggest that CGEC can cause adverse reactions/events in patients with IBS-D. Conclusions: Low or very low certainty evidence indicated that there was no difference between CGEC and WCM for the treatment of IBS-D. The combination of CGEC and WCM had a better therapeutic effect than WCM alone for the treatment of IBS-D.