944 Original article
Osteopathy improves the severity of irritable bowel
syndrome: a pilot randomized sham-controlled study
Blanche-Maëlle Florancea, Gregory Frinb, Raffaella Daineseb,
Marie-Hélène Nébot-Vivinusc, Eugénia Marine Barjoand, Sophie Marjouxb,
Jean-Pierre Laurensa, Jean-Luc Payrousea, Xavier Hébuterneb
and Thierry Picheb,c
Background Effective therapies for irritable bowel
syndrome (IBS) are disappointing. Therefore, IBS patients
have a growing interest for alternative medicines including
osteopathy.
Aim We aimed to evaluate the effect of osteopathy on the
severity of IBS in a randomized sham-controlled trial.
Methods We prospectively assigned 30 patients with IBS
(23F, 7M, mean age 45.8±16.4 years) fulfilling the Rome III
c 2012 Wolters Kluwer Health |
criteria in a 2/1 ratio to receive either osteopathy or sham
osteopathy. Two separate sessions were performed at
a 7-day interval (days 0 and 7) with a further 3 weeks
of follow-up (day 28). The primary outcome included at
least a 25% improvement in the IBS severity score at day 7.
The secondary outcomes included the impact of IBS on
quality of life, psychological factors, and bowel habits.
Results The severity of IBS decreased in both groups
at days 7 and 28. At day 7, this decrease was significantly
more marked in patients receiving osteopathy compared
with those receiving the sham procedure (– 32.2±29.1 vs.
– 9.0±16.0, mean difference normalized to the baseline
P = 0.01). This difference did not persist at day 28 (P = 0.4).
Introduction
The irritable bowel syndrome (IBS) affects 10–20% of the
adult population worldwide and causes significant morbid-
ity, quality-of-life impairment, and burden on the health-
care system [1,2]. Although IBS has a high prevalence,
its underlying mechanism is not fully understood, being of
multifactorial origin, including abnormalities in gut motility
and sensitivity, activated gut immunity, and disturbances
in brain–gut interactions, with psychological disorders [3].
Because of the wide range of symptoms that may be expe-
rienced, the pharmacological treatments available for IBS
are mainly targeted at symptom reduction.
As conventional IBS treatments provide only minor clini-
cal benefit, a growing number of complementary alter-
native medicine modalities are becoming attractive options
for many patients. Therefore, natural products including
herbal medicine, peppermint oil, exclusion diet, probiotics
and prebiotics, and mind–body medicines including hyp-
nosis, acupuncture, meditation, manipulative, and body-
0954-691X
c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Both anxiety and depression scores decreased without
difference between groups. Stool frequency and
consistency were not significantly modified.
Conclusion Osteopathy improves the severity of IBS
symptoms and its impact on quality of life. Osteopathy
should therefore be considered for future research
as an effective complementary alternative medicine
in the management of IBS symptoms. Eur J Gastroenterol
Hepatol 24:944–949
Lippincott Williams & Wilkins.
European Journal of Gastroenterology & Hepatology 2012, 24:944–949
Keywords: irritable bowel syndrome, irritable bowel syndrome severity
score, osteopathy
a
Osteopathic Center ATMAN, Sophia-Antipolis, bGastroenterology Department,
Archet 2 Hospital, cInserm 576, Immunology Department, Archet 1 Hospital and
d
Epidemiology Department, Archet 1 Hospital, CHU of Nice, University of Nice
Sophia-Antipolis, France
Correspondence to Thierry Piche, MD, PhD, Gastroenterology and Inserm 576,
Archet 2 Hospital, CHU of Nice, France
Tel: + 33 492 036 399; fax: + 33 492 036 575;
e-mail: piche.t@chu-nice.fr
Received 25 January 2012 Accepted 29 March 2012
based practices based on reflexology have been proposed
to IBS patients with various benefits [4]. The osteopathic
treatment could be of specific interest in IBS patients.
Treatment consists of gentle stretching, mobilizing, and
manipulating procedures applicable to various tissues and
parts of the body, including the musculoskeletal and vis-
ceral systems [5]. One of its main principles is the inter-
relationship of structure and function, the goal being to
restore movement within the environment of an abdominal
organ or article. The concept of osteopathy is appealing
now that there is greater appreciation of the role of the
brain–gut axis in functional gastrointestinal disorders such
as IBS. Interestingly, an osteopathic approach such as
vertebral and abdominal manipulations may affect the
sympathetic tone [6], which is shown to be altered in IBS
patients [7]. To date, only one controlled study from the
Netherlands has been carried out in IBS patients with
a 6-month follow-up. In this study, in the osteopathic
group, 68% of patients experienced a definite overall
improvement in symptoms and 27% experienced a slight
DOI: 10.1097/MEG.0b013e3283543eb7

improvement, whereas only 18% experienced an overall
improvement and 59% experienced a slight improvement
while on standard care [8].
Therefore, the primary aim of this study was to evaluate
the effect of osteopathy on the severity of IBS. The
secondary outcomes were to assess the efficacy of oste-
opathy on quality of life, psychological factors, and bowel
habits in these patients. We performed a randomized
sham-controlled single-blind trial testing two sessions of
standardized osteopathy at a 7-day interval, followed by a
3-week follow-up period.
Methods
Participants
Consecutive patients who fulfilled the Rome III criteria [1]
for the diagnosis of IBS were seen in the Department
of Gastroenterology of the Centre Hospitalier Universitaire
de Nice between March 2009 and February 2011.
Symptoms of IBS (e.g. abdominal pain and/or discomfort,
change in stool frequency) had to be present more than
25% of the time, being evaluated by means of daily diaries
completed during 10 days including a Bristol Stool Form
Scale. IBS subtypes were divided as predominance of con-
stipation (IBS-C) or diarrhea (IBS-D). We did not include
patients with mixed symptoms because of the inherent
variability in symptoms in this IBS subtype. Patients were
examined thoroughly and were subjected to biological tests
to exclude an organic disease: celiac disease, inflammatory
bowel diseases, lactose intolerance, severe depression and
anxiety, and thyroid and renal dysfunction. Patients with
rheumatologic disease or symptoms were not included.
Patients were instructed to continue their usual treatment
for IBS including antispasmodics, laxatives, or loperamide
without modifying the doses during the entire study.
Dietary habits were also unchanged during the 3 previous
months before inclusion and during the entire study. None
were taking antidepressants, anti-inflammatory drugs
(steroids), or analgesic (paracetamol, aspirin). None were
smokers or alcohol consumers. Patients were not included
if they were well aware and/or had previously been treated
with osteopathy to ensure an optimal blinding.
Study protocol
Thirty eligible IBS patients fulfilling the Rome III
criteria [1] were randomly assigned in a 2/1 ratio to
receive either osteopathy (treatment group) or sham
osteopathy (control group). A 2 : 1 unequal allocation was
used to increase patient acceptability and for maximizing
participants’ exposure to treatment. Two sessions of
manipulative procedures were performed at a 7-day
interval with a further 3-week period of follow-up. The
osteopath was not aware of the IBS subtype and was not
involved in data analysis to optimize the blinding of the
study. Patients were instructed to complete a stool diary
each day during 10 days before the study (diary 1) and 10
days before ending the follow-up (diary 2). The stool
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Osteopathy is effective in IBS Florance et al. 945
frequency corresponded to the average number of bowel
movements per day assessed on the diary. The stool form
was evaluated through the mean of numbers associated
with the stool picture from the Bristol Stool Form Scale
(1, separate hard lumps like nuts; 2, sausage shaped but
lumpy; 3, like a sausage but with cracks on its surface; 4,
like a sausage or a snake, smooth and soft; 5, soft blobs
with clear-cut edges; 6, fluffy pieces with ragged edges,
a mushy stool). All participants were evaluated under the
same conditions in the morning at the inclusion visit (day
0), on days 7 and 28. Each participant completed the
French validated IBS severity scoring system [9]. Quality
of life and psychological variables were also assessed
through a set of questionnaires including the fatigue im-
pact scale (FIS), the Beck Depression Inventory (BDI),
and the Hospital Anxiety and Depression Scale. All
patients gave their written informed consent.
The osteopathic procedure was performed by a single
osteopath and standardized as follows: the focus in treat-
ment, therefore, went beyond simple spinal alignment, to
dealing directly with the abnormal body physiology using
an array of direct and indirect techniques [10]. By def-
inition, direct techniques produce a change in the body
by working against a barrier of resistance in the tissue,
and indirect techniques produce a change in the body by
moving tissue away from a barrier, allowing the vectors of
force within the tissue to reach a new point of balance.
Each session began with a physical examination and inter-
vention, paying special attention to the spine and the
abdomen. The direct technique included pressure on
each segment of the spine with the hands for 90 s. This
was completed by an indirect technique, during which
the patient was properly positioned and the osteopath
manipulated in all directions. In the indirect method,
pressure was applied to the manipulated segment with
the help of the hand, knee, or the chest. Each session was
completed by visceral osteopathy to relieve imbalances
and restrictions in the interconnections between the
motions of all the organs. Each session was performed for
60 min. The sham procedure consisted only of a gentle
massage of the same part of the body including both the
spine and the abdomen at the same time.
Irritable bowel syndrome severity and impact
on quality of life
Each individual was asked to complete the French vali-
dated IBS severity scoring system initially developed by
Francis et al. [9] and subsequently used in cohorts of IBS
patients in France [11,12]. The questionnaire is com-
posed of 1–2 items assessing the presence of abdominal
pain and bloating (answer yes or no), 2–4 visual analog
scales measuring the intensity of pain, bloating, relief
following defecation, and the impact of symptoms on the
general quality of life, 3– an item on the number of days
of suffering during the preceding 10 days. The total score
of the questionnaire ranges from 0 to 500 and provides
946 European Journal of Gastroenterology & Hepatology 2012, Vol 24 No 8

a qualitative assessment of severity(< 75 = remission; risk a. The maximum attrition rate was assumed to be
75–175 = mild IBS; 175–300 = moderate IBS; and >300 10%. Parameters of the study population were compared
= severe IBS). using w2 for qualitative variables and Kruskall–Wallis and
Mann–Whitney nonparametric tests for quantitative
The severity of abdominal pain/discomfort was scored 0–4 variables. Paired tests were also used for the comparison
according to its impact on patients’ daily activities [11]: of quantitative data in the same group at different times.
0, absent; 1, mild (not influencing activities); 2, relevant Data are expressed as means and SD.
(diverting from, but not urging modification of activities);
3, severe (influencing activities markedly enough to urge Results
modifications); and 4, extremely severe (precluding daily Baseline characteristics of irritable bowel syndrome
activities). patients
Thirty patients were included and completed the entire
Fatigue protocol; 20 received osteopathy and 10 received the
Fatigue was measured using the French version of the FIS sham procedure. None of the patients were lost to follow-
questionnaire, which was initially translated into French up. There were no significant differences at baseline
and validated in a cohort of healthy blood donors in between the osteopathy and the sham procedure groups
Montreal and subsequently in patients with IBS [13]. FIS with respect to age, sex, duration of disease, the severity
is a self-report questionnaire consisting of 40 statements of IBS, and its impact on quality of life, fatigue, anxiety,
that describes possible manifestations of fatigue; these depression, and the proportion of IBS subtypes (Table 1).
statements are divided into three categories [cognitive
(n = 10), physical (n = 10), and psychosocial (n = 20)]. Severity of irritable bowel syndrome and quality of life
Each item is rated on a five-point scale of distress, ranging On day 0, the severity of IBS was 300±71 in the
from 0 (‘no problem’) to 4 (‘extreme problem’), with a osteopathy group and 275±92 in the sham procedure
maximum of 160 points. group (NS). Treatment with osteopathy significantly
reduced the severity of IBS at day 7 (196±88, P < 0.01)
Depression and day 28 (224±102, P < 0.01), corresponding to a 33.7
Depression was assessed using the short version of the and 25.5% improvement, respectively. The sham proce-
BDI, a well-standardized 13-item measure of the cognitive, dure also reduced the severity of IBS, with a 16%
affective, and somatic symptoms of depression available improvement at day 7 (244±75, P = 0.04) and an almost
in French [14]. The short 13-item BDI contains only significant 24% improvement at day 28 (228±119, P =
a pertinent item that correlates significantly with both the 0.07) (Fig. 1). When normalized to baseline, the reduc-
global score of the original 21-item form and the clinical tion in the severity of IBS at day 7 was significantly more
evaluation of depression by physicians [14]. Four sentences pronounced in patients treated with osteopathy com-
are included in each item, rating from 0 to 3 in function of pared with the sham procedure (P = 0.01), whereas no
the severity of a symptom. significant difference was observed at day 28 (P = 0.8)
(Fig. 1 and Table 2). No significant difference was also
Anxiety observed between IBS subtypes.
The Hospital Anxiety and Depression Scale is a reliable
Similar to the variation in the severity of IBS, the
instrument with a ‘cutoff ’ score for screening for clinically
improvement in quality of life normalized to baseline was
significant anxiety and depression and has also been
shown to be a valid measure of the severity of these dis-
orders of mood [15]. This self-assessment scale consists Table 1 Clinical characteristics of irritable bowel syndrome
of 14 items, each using a four-grade Likert scale (0–3), patients at baseline
with subscales for anxiety including seven items. The Osteopathy Sham procedure P
score varies with the severity of anxiety and depression.
Sex (male/female) 5M/15F 2M/8F 0.7
Age (years) 47.5±15.8 47.5±17.8 0.5
Level of satisfaction IBS severity score 300±71 275±92 0.2
Impact of abdominal pain severity 2.2±0.7 1.6±0.9 0.06
The level of satisfaction was assessed at the end of the on quality of life
study by asking patients their global appreciation of oste- Impact of abdominal pain frequency 2.8±0.9 2.9±1.1 0.7
opathy and whether they would agree to pay for sub- on quality of life
FIS score 61.8±31.9 53.1±43.4 0.8
sequent manipulative procedures. HAD score 15.6±7.4 17.2±7.8 0.5
Beck score 8.5±4.4 9.2±6.3 0.8
Duration of IBS (years) 11.3±9.8 11.4±17.9 0.1
Statistical analysis
IBS-D, IBS-C 11/9 3/7 0.2
The sample size was calculated at 24 and 12 evaluable
patients, respectively, in each group for an expected sig- Data are means and SD.
FIS, fatigue impact scale; HAD, Hospital Anxiety and Depression Scale; IBS,
nificant reduction in the IBS severity score of 25% with irritable bowel syndrome; IBS-C, irritable bowel syndrome with constipation;
osteopathy versus sham osteopathy with a 5% adjusted IBS-D, irritable bowel syndrome with diarrhea.

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 Osteopathy is effective in IBS Florance et al. 947

significantly more marked at day 7 in patients treated
with osteopathy compared with the sham procedure (P =
0.03), whereas there was no significant difference
between groups at day 28 (P = 0.6) (Table 2).
Data of stool frequency and consistency are detailed
in Table 3 for IBS-D and IBS-C. In both subtypes, the
average frequency and form of bowel movement were not
significantly different between osteopathy and the sham
procedure. In IBS-D, a statistical trend favoring greater
improvement in stool frequency was observed with oste-
opathy compared with the sham procedure (– 0.1±0.2 vs.
0.5±1.2 bowel movements/day, P = 0.067). Moreover,
there was no change in the IBS phenotype throughout
the study.
Psychological variables
The total score of fatigue was not significantly reduced
over time either in patients receiving osteopathy (61.8±
31.9 at day 0, 57.2±33.3 at day 7, and 51.3±31.0 at day
28, NS) or in patients treated with the sham procedure
(53.1±43.4 at day 0, 51.2±47.2 at day 7, and 45.1±44.0
Fig. 1
IBS severity score
(mean±SD)
320
Severe
300
Moderate
280
260
240
220
200
180 P = 0.01
Mild
160
Day 0 Day 7
Sham osteopathy Osteopathy
Evolution of the severity of irritable bowel syndrome (mean±SD) in
patients receiving osteopathy (dark) or sham osteopathy (white) at days
0, 7, and 28. P = 0.01 between osteopathy and sham osteopathy at day
7. IBS, irritable bowel syndrome.
at day 28, NS). There was no significant difference at any
time between the groups.
At day 0, the BDI score was 8.5±4.4 in the osteopathy
group and 9.2±6.3 in the sham procedure group (NS). In
patients treated with osteopathy, the BDI score did not
change significantly at day 7 (7.7±5.5, P = 0.2 vs. day 0),
but decreased significantly at day 28 (4.9±1.8, P < 0.01
vs. day 0 and P = 0.05 vs. day 7). In patients receiving
the sham procedure, the BDI score remained unchanged
at day 7 (7.6±4.8, P = 0.07 vs. day 0) and decreased sig-
nificantly at day 28 (4.4±2.2, P = 0.01 vs. day 0 and
P = 0.04 vs. day 7). There was no significant difference at
any time between the groups.
At day 0, the HAD score was 15.6±7.4 in patients treated
with osteopathy and 17.2±7.8 in patients receiving the
sham procedure (NS). In patients treated with osteo-
pathy, the HAD score remained unchanged at day 7
(15.7±7.8, P = 0.7 vs. day 0), but decreased significantly
at day 28 (6.7±4.7, P < 0.01 vs. day 0 and P < 0.01 vs. day
7). In patients receiving the sham procedure, the HAD
score was not significantly changed at day 7 (16.4±7.2,
P = 0.5 vs. day 0) and decreased significantly at day 28
(6.2±5.5, P < 0.001 vs. day 0 and P < 0.001 vs. day 7).
There was no significant difference at any time between
the groups.
Satisfaction of the patients
At the end of the study, the level of satisfaction was
significantly higher in the group of IBS patients treated
with osteopathy (14/20, 70%) compared with those treated
with the sham procedure (4/10, 40%, P = 0.03).
Safety and tolerance
Both osteopathy and sham procedures were well toler-
ated, without any significant side-effects.
Day 28 Discussion
In this study, we have shown that a standardized oste-
opathic technique was effective in decreasing the severity
of IBS, in particular abdominal pain, for a short-term
duration. Our data indicate a specific effect of osteopathy
as the clinical improvement with the sham procedure was
significantly less pronounced. Anxiety and depression
scores improved at the end of follow-up but at similar

Table 2 Severity of irritable bowel syndrome and psychological outcomes normalized to baseline after osteopathy or the sham procedure
Variation between days 7 and 0 Variation between days 28 and 0

Osteopathy Sham procedure P Osteopathy Sham procedure P

IBS severity score – 32.2±29.1 – 9.0±16.0 0.01 – 22.9±34.3 – 18.9±24.4 0.7

Impact of abdominal pain severity on quality of life – 24.1±45.0 12.5±35.8 0.03 – 6.6±50.8 – 2.5±41.0 0.6
FIS score – 6.9±30.4 – 7.9±44.6 0.9 – 7.4±62.3 – 19.0±44.6 0.9
HAD score – 45.0±83.4 – 62.9±26.4 0.5 1.1±18.7 1.6±23.1 0.5
Beck score – 15.3±38.1 – 14.1±24.0 0.9 – 23.8±61.3 – 36.5±65.5 0.6

Data are variations normalized to baseline and expressed as means and SD.
FIS, fatigue impact scale; HAD, Hospital Anxiety and Depression Scale; IBS, irritable bowel syndrome.

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948 European Journal of Gastroenterology & Hepatology 2012, Vol 24 No 8
Table 3 Changes in the bowel habits of irritable bowel syndrome
patients
Diary 1 Diary 2
Stool frequency Stool Stool frequency
(BM/day) form (BM/day)
IBS-D
Osteopathy 1.9±0.5 5.0±0.6 1.5±0.4
Sham 1.1±0.5 5.0±0.0 1.3±0.2
procedure
IBS-C
Osteopathy 0.3±0.1 1.6±0.7 0.5±0.2
Sham 0.2±0.0 1.4±0.5 0.4±0.1
procedure
Stool frequency corresponds to the average number of bowel movements per day
assessed in 10 days diary before entering (diary 1) and ending (diary 2) the study.
Stool form was assessed by meaning numbers of stool pictures from the Bristol
Stool Form Scale. Data are means and SD.
BM, bowel movement; IBS, irritable bowel syndrome; IBS-C, irritable bowel
syndrome with constipation; IBS-D, irritable bowel syndrome with diarrhea.
levels in both groups. However, osteopathy had no effect
on the bowel habits of IBS patients (e.g. stool frequency
and consistency). Finally, the clinical benefit of osteo-
pathy was not sustained over 28 days of follow-up.
A number of factors are likely to explain the increasing
interest in complementary alternative therapies that is
considered by up to 30% of IBS patients [8]. First,
traditional medical therapies for IBS only offer limited
therapeutic gains over placebo [16,17]. Further, in many
countries, prescription medication insurance coverage for
IBS and other ‘quality-of-life’ conditions is decreasing.
Finally, perhaps related to concerns regarding the safety
of prescription medications, there appears to be a growing
desire among patients for more holistic and ‘natural’
treatment options with certain benefits [18]. However,
further data on the efficacy and safety of alternative
therapies are urgently needed.
Surprisingly, there has been very little research into the
treatment of IBS using manual therapy techniques, in
particular osteopathy. In a pilot open randomized study
including 39 individuals, Hundscheid et al. [8] reported
that five osteopathic procedures during 2–3 weeks con-
ferred a sustained 6-month clinical benefit compared
with the standard care option (e.g. medical care) on
overall symptom, quality of life, and IBS severity. How-
ever, this interesting and encouraging study was flawed by
the absence of a true control group and the inherent
variations in the osteopathic black box method, the indi-
vidual approach to osteopathic treatment depending on
the diagnostic findings of the osteopath. In the present
study, each patient was treated with a similar manual pro-
cedure irrespective of the diagnosis findings of the oste-
opath. We also used a sham procedure, being conscious of
the limitation of blinding because of possible patient
knowledge of the osteopathic technique. Finally, the
severity of IBS was assessed soon after (e.g. 7 days) each
session to avoid inherent variations in IBS symptoms over
long time periods. Thus, one session of osteopathy in-
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
duced a significant improvement in the severity of IBS, in
particular, abdominal pain and bloating. Finally, similar
clinical improvements in IBS-C and IBS-D subtypes
Stool
suggest that manual treatment should be proposed to IBS
form patients irrespective of their predominant gut motility
dysfunction.
5.0±0.4
5.3±0.5
Beside abdominal pain and altered bowel habits, IBS
patients are likely to complain of a variety of other
nongastrointestinal somatic disorders, increasing their
1.8±0.6
1.7±0.7 healthcare utilization, including fatigue, depression, and
anxiety [19,20]. In the present study, depression and
anxiety scores were equally reduced, without any differ-
ence between osteopathy or the sham procedure. Interest-
ingly, the improvement in anxiety and depression occurred
only after relief of gut symptoms was achieved, suggesting
that psychological factors were mostly a consequence of
chronic abdominal pain.
In this study, we did not evaluate the underlying mecha-
nisms of osteopathy on gut function. Both central and
peripheral factors contribute to a biopsychosocial con-
ceptualization of the pathogenesis and clinical expression
of IBS [21,22]. In theory, there are a number of ways
to promote an osteopathic approach in IBS. Obviously,
treatment of patients with osteopathy can be compared
with a behavioral therapy. However, our findings suggest
a specific effect of osteopathy as the sham procedure was
less effective. In fact, osteopathic techniques, such as
articulation manipulation and soft tissue massage to these
areas, may affect the sympathetic tone [6], which was
shown to be altered in IBS patients [7]. This effect on
autonomic function may be one explanation for the supe-
riority of osteopathy compared with soft massage of the
same areas (e.g. sham procedure). Whether vertebral and/
or visceral manipulation should be preferred to treat IBS
is currently unknown. Our findings also suggest that oste-
opathy sessions should be repeated with less than a 1-month
interval to sustain the clinical benefit. Finally, osteopathy
has also been shown to improve cardiac indices [23] and
lymph flow rates through the thoracic duct [24].
Our study also has some drawbacks that need to be
mentioned. Clearly, the sample size was estimated to assess
the effect of one session of a manipulative technique
assuming that a 25% decrease in the severity of IBS could
be significantly more marked compared with the sham
procedure. We used unequal 2/1 randomization to increase
patient acceptability and the recruitment rate. However,
the small sample size may have underpowered the findings
on bowel habits. Moreover, we did not plan a cross-over
design because IBS is likely to be prone to a carry-over
effect. In this study, the follow-up of symptoms was short,
being restricted to 15 days after the treatment was stopped.
Finally, it is not clear whether the benefits of real and sham
osteopathy over ‘usual care’ are a consequence of the in-
teraction between the complementary alternative medicine
provider and IBS patients.

Conclusion
This pilot study has identified a clinical benefit of oste-
opathy over sham osteopathy to relieve the severity of
IBS patients while on standard medical care, with a very
low likelihood of side-effects. Osteopathy should therefore
be considered as a possible effective complementary
alternative medicine in the management of IBS symptoms.
The long-term outcome of IBS after osteopathy should be
further explored in larger trials.
Acknowledgements
All patients of this study were included in a research
project of both the pathogenesis and the treatment of IBS
(Programme Hospitalier de Recherche Clinique, PHRC
2007–2008 of the CHU of Nice) with the ethic ap-
proval of the ‘Comité de Protection des Personnes’ on
6 November 2007 (No. 07.047).
Conflicts of interest
There are no conflicts of interest.
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