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Hypnotherapy for IBS

Systematic review
Results
Mind over bowel?

Irritable bowel syndrome (IBS) is common, with each UK GP seeing an average of about eight patients every week. It is unpleasant for sufferers, negatively affects quality of life, and is expensive for health services. A large proportion of patients do not do well with conventional therapy, and many seek unconventional alternatives.

One of these is a form of hypnotherapy known as gut-directed hypnotherapy. It is based on relaxation to try to normalise gut function. Because there are claims that it works, some purchasers are tempted to provide a service. A systematic review of trials [1] suggests a large degree of caution is warranted.

Systematic review


Authors sought studies, of any design, in nine electronic databases, and even contacted authors for information about any further studies.

Results


Eighteen unique studies were identified and included in the review, four randomised trials, two controlled trials, and 12 uncontrolled studies. All concluded that hypnotherapy had some beneficial effect.

The four randomised trials studied 153 patients. They used five to 12 gut directed hypnotherapy sessions in patients who were mostly refractory to conventional therapy. Controls tended to receive usual monitoring, though one trial used supportive psychotherapy. About half the patients were in trials of 12 weeks, and the remainder in one trial with 12 months follow up.

Three smaller studies indicated some significant statistical improvement, usually in symptom scores at 12 weeks. The largest trial with the highest quality score indicated that differences were not maintained at six months.

Mind over bowel?


It sounds familiar. This is exactly what we find in so many reviews of unconventional therapy. By now we should have learned the lesson, that without good evidence hope is likely to be trumped by later experience.

The authors conclude, rightly, that there is far too little evidence to justify use of hypnotherapy in any circumstance. At least one good quality, large trial, with long follow up should be the absolute minimum requirement for efficacy, but would still be less than what we expect for medicines, where two positive trials are needed. Don't hold your breath.

Reference:

  1. S Wilson et al. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Alimentary Pharmacology and Therapeutics 2006 24: 769-780.

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