Boswellia serrata for Inflammatory Bowel Disease
Boswellia serrata has only weak, mostly old human evidence for inflammatory bowel disease: early small trials hinted at benefit in active disease, but the single highest-quality placebo-controlled trial found no benefit, so it cannot be recommended as a substitute for standard IBD therapy.
Why this grade7-layer evidence engine
The grade is held to Weak (C) because the human evidence is thin, dated, and contradictory. Three early trials looked encouraging — a 1997 open-label ulcerative colitis study reported 82% remission versus 75% on sulfasalazine (PMID 9049593), a 2001 open-label chronic colitis trial showed 70% versus 40% remission (PMID 11488449), and a double-blind active-comparator study in active Crohn's found the H15 extract non-inferior to mesalazine (PMID 11215357). But all were small, several were open-label, and the Crohn's trial used a non-inferiority design with no placebo, which limits any efficacy claim.
Crucially, the best-quality trial was negative. Holtmeier 2011, a double-blind, placebo-controlled study in 82 Crohn's patients over 52 weeks, found Boswellia no better than placebo for maintaining remission (59.9% vs 55.3%, P=0.85) (PMID 20848527). A 2020 systematic review concluded the efficacy signal rests on single small RCTs and is insufficient for routine clinical use (PMID 31701598). No modern, large trials exist, which keeps confidence low.
Authorities are mixed and cautious. A WHO monograph lists IBD among clinically supported uses, but it reflects older compiled data and predates the negative 2011 trial. The US FDA recognizes Boswellia only as a flavoring agent and has issued warning letters against disease-treatment claims, while Mayo Clinic, Cleveland Clinic, Harvard Health, the NIH Office of Dietary Supplements, and major gastroenterology societies do not endorse it for IBD. Given drug-interaction risks, it should not replace proven therapies.
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditable▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.472
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 無高階證據可裁決
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status