SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 1 | 21 4. Outcome assessment The primary outcomes assessed were the efficacy of Aloe compared with placebo on global IBS symptoms after treatment, including patients’ improvement of symptoms or self-reported quality of life. These included various self- reported measurement scales such as the Gastrointestinal Symptoms Rating Scale (GSRS), visual analogue scale (VAS), EuroQol (EQ5D), Short Form 12 (SF12) and Short Form 36 (SF36) quality of life questionnaires. This choice of primary outcome is in keeping with most studies reported to date. Any adverse events in the selected studies were also reported on and summarized. Data extraction Two reviewers (FF and IS) independently extracted data onto a Microsoft Word data extraction form. The following data was extracted for each trial: Study design, setting, type and form of intervention (including dose), duration of treatment, IBS diagnosis criterion used, and primary and secondary outcome measures. 5. Study quality Two reviewers (FF and IS) assessed study quality independently according to the Cochrane tool for Risk of Bias assessment. This assessed aspects of study included selection bias (dealing with confounding, adjustment and comparability of groups), performance bias (in terms of the fidelity of the interventions); detection bias (regarding unbiased and correct assessment of outcomes, including blinding of assessors); attrition bias (with regard to completeness of sample, follow-up and data); and reporting bias (with regard to publication biases and selective reporting of results). Studies were scored as having low, moderate or high risk of bias. 2.7. Data synthesis and statistical analysis The individual study authors’ assessments were used as to what constituted a response to treatment in order to recode trial data into a dichotomous outcome of response versus non-response to treatment. Where necessary, the authors of the selected studies were contacted for missing data. If the authors are not able to respond, or if they could not provide the data requested, missing data was indicated in the review. Data was pooled using a random effects model to give a more conservative estimate of the effect of individual treatments, allowing for heterogeneity between studies. The effects of different interventions were expressed as a Risk Ratio with 95% confidence interval (CI) of global symptoms of irritable bowel syndrome persisting with Aloe compared with placebo. Statistical heterogeneity in each meta-analysis was assessed using the χ2 test and quantified using the statistic with a cut-off point of 25% to assess heterogeneity between studies. It was planned to do sub-group analysis according to IBS sub-type. The final data was analysed with Review Manager V.5.3 statistical software 43 , and references were managed using the Mendeley citation manager. 44 3. RESULTS The search strategy generated 2,386 citations, and an additional 13 articles were identified separately through snowballing and random searches in Google scholar. Out of this total, 139 were duplicates and the remaining 1974 were potentially relevant and retrieved for assessment. Of these, 1,948 were excluded and the remaining 26 studies were assessed for full-text eligibility. The full-text assessment resulted in six eligible RCTs, which compared Aloe or Aloe in combination with other compounds with placebo. The PRISMA diagram in Figure 1 shows the flow of information through the various phases of the systematic review. It maps the number of records identified, included and excluded, as well as those that were finally included in the meta-analysis. RESEARCH Table 1: PubMed search strategy, modified as needed for use in other databases Subject/ Related term SearchTerms PubMed search strategy #1 Intestinal diseases, colonic diseases, irritable bowel syndrome, gastrointestinal motility, irritable colon, peristalsis, constipation, diarrhea, feces, stool, abdominal pain, bloating, defecation, laxatives, bulking agent, dysmotility, visceral hypersensitivity, spastic colon, Rome criteria intestinal diseases”[MeSH Terms] OR “colonic diseases”[MeSH Terms]) OR “irritable bowel syndrome”[MeSH Terms]) OR irritable bowel syndrome[Title/Abstract]) OR “gastrointestinal motility”[MeSH Terms]) OR “irritable bowel syndrome”[MeSH Terms]) OR irritable colon[Text Word]) OR “peristalsis”[MeSH Terms]) OR peristalsis[Title/Abstract]) OR “constipation”[MeSH Terms]) OR constipation[Text Word]) OR “diarrhea”[MeSH Terms]) OR diarrhea[Text Word]) OR “feces”[MeSH Terms]) OR stool[Text Word]) OR “feces”[MeSH Terms]) OR feces[Text Word]) OR abdominal pain[Title/Abstract]) OR abdominal pain[Text Word]) OR “defecation”[MeSH Terms]) OR defecation[Text Word]) OR “laxatives”[MeSH Terms]) OR laxative[Title/Abstract]) OR bulking agent[Title/Abstract]) OR dysmotility[Text Word]) OR visceral hypersensitivity[Text Word]) OR spastic colon[Title/ Abstract]) OR spastic colon[Text Word]) OR Rome criteria[Text Word]) OR bloating[Title/Abstract]) OR “abdominal pain”[MeSH Terms]) OR abdominal pain[Title/Abstract] #2 Xanthorrhoeaceae, Aloe, Asphodelaceae, Aloeaceae, Aloeandongensis, Aloedent, Aloe emodin, aloe*, emodin, barbaloin “xanthorrhoeaceae”[MeSH Terms] OR Xanthorrhoeaceae[Text Word]) OR “aloe”[MeSH Terms]) OR (aloe[Title/Abstract] OR aloe’[Title/Abstract] OR aloe’s[Title/Abstract] OR “Asphodelaceae”[MeSH Terms] ORAsphodelaceae[Text Word] OR aloeaceae[Title/Abstract] OR aloeandongensis[Title/Abstract] OR aloedent[Title/Abstract] OR “aloe emodin”[Title/Abstract] OR aloei[Title/Abstract] OR aloeicola[Title/Abstract] OR aloemannan[Title/Abstract] OR aloemodin[Title/Abstract] OR aloenin[Title/Abstract] OR aloepecia[Title/Abstract] OR aloeresin[Title/Abstract] OR aloeride[Title/Abstract] OR aloes[Title/Abstract] OR aloes’[Title/Abstract] OR aloesin[Title/Abstract] OR aloesinol[Title/Abstract] OR aloesol[Title/Abstract] OR aloesone[Title/Abstract] OR aloesorb[Title/Abstract] OR aloespanoarin[Title/Abstract] OR aloestron[Title/Abstract] OR aloeswood[Title/ Abstract] OR aloethanes[Title/Abstract] OR aloetic[Title/Abstract] OR aloetica[Title/Abstract] OR aloeticola[Title/ Abstract] OR aloetron[Title/Abstract] OR aloeus[Title/Abstract] OR aloev[Title/Abstract] OR aloeVera[Title/ Abstract] OR aloeVerae[Title/Abstract] OR aloeverose[Title/Abstract] OR aloexylon[Title/Abstract])) OR Aloctin[Text Word]) OR aloin[Title/Abstract]) OR aloin[Text Word]) OR “emodin”[MeSH Terms]) OR emodin[Text Word]) OR barbaloin[Text Word] Search #1 AND #2 Filters: Publication date from 1970 to 31 August 2018