Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Published on Apr 10, 2020in Gut19.819
· DOI :10.1136/GUTJNL-2020-321191
Christopher J Black13
Estimated H-index: 13
Elyse R. Thakur1
Estimated H-index: 1
+ 3 AuthorsAlexander C. Ford86
Estimated H-index: 86
Objectives National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty. Design We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score. Results We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated. Conclusions Several psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base and were the most efficacious long term. Trial registration number The study protocol was published on the PROSPERO international prospective register of systematic reviews (registration number CRD 42020163246).
Figures & Tables
📖 Papers frequently viewed together
135 Citations
109 Citations
27 Citations
#1Taryn J. Lores (University of Adelaide)H-Index: 2
#1Taryn Lores (University of Adelaide)H-Index: 1
Last. Jane M. Andrews (University of Adelaide)H-Index: 55
view all 8 authors...
Abstract Background & Aims Inflammatory bowel diseases (IBD) are associated with high psychosocial burden and economic cost. Integrating psychological care into routine management might lead to savings. We performed a 2-year investigation of the effects of integrated psychological care in reducing healthcare use and costs. Methods We performed a prospective study of 335 adult patients treated at a hospital-based IBD service in Australia. Participants were recruited between September 2015 and Aug...
10 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 3 authors...
: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder affecting 1 in 10 people and associated with poor psychological health, reduced quality of life, and increased health care expenditure.1 The etiology is complex and incompletely understood.2 Approximately one-third of patients have IBS with constipation (IBS-C),1 for which there are licensed therapies available in the United States. We summarized comparative efficacy of these in a recent network meta-analysis of randomized c...
26 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Yuhong Yuan (McMaster University)H-Index: 35
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 7 authors...
Summary Background Although novel therapies for irritable bowel syndrome (IBS) continue to be developed, many doctors rely on more established, traditional therapies as first-line or second-line treatment options. These therapies include soluble fibre (eg, ispaghula husk), antispasmodic drugs, peppermint oil, and gut–brain neuromodulators (including tricyclic antidepressants, selective serotonin reuptake inhibitors, or α-2-δ calcium channel subunit ligands). However, the relative efficacy of tra...
32 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 8 authors...
Objective Over half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. Design We searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and Clinicaltrials.gov through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy ...
49 CitationsSource
#1Hazel Everitt (University of Southampton)H-Index: 22
#2Sabine Landau (University of Cambridge)H-Index: 70
Last. Rona Moss-Morris (University of Cambridge)H-Index: 70
view all 15 authors...
Objective To evaluate the clinical effectiveness of two modes of cognitive–behavioural therapy (CBT) for IBS compared with treatment as usual (TAU) in refractory IBS. Design A three-arm randomised controlled trial assessing telephone-delivered CBT (TCBT), web-based CBT (WCBT) with minimal therapist support, and TAU. Blinding participants and therapists was not possible. Chief investigator, assessors and statisticians were blinded. Participants were adults with refractory IBS (clinically signific...
82 CitationsSource
#1Taryn J. Lores (Royal Adelaide Hospital)H-Index: 2
#2Charlotte Goess (Royal Adelaide Hospital)H-Index: 5
Last. Jane M. Andrews (Royal Adelaide Hospital)H-Index: 55
view all 8 authors...
BACKGROUND AND AIMS: Inflammatory bowel disease is associated with psychosocial issues which reduce quality of life and impair medical management. However, these issues are rarely addressed in routine care. A model of integrated psychological screening and intervention was trialled to measure prevalence, patient participation, and potential benefits to mental health and/or quality of life. METHODS: During a 12-month period, 490 adult patients at an established hospital-based service were approac...
17 CitationsSource
#1Yuri A. Saito (Mayo Clinic)H-Index: 28
#2Ann E. Almazar (Mayo Clinic)H-Index: 6
Last. Nicholas J. Talley (University of Newcastle)H-Index: 183
view all 8 authors...
BACKGROUND: Pregabalin is a calcium channel α2δ ligand that modifies visceral hypersensitivity in IBS patients. Clinical data for pregabalin in IBS are lacking. AIM: To test the efficacy of pregabalin on gastrointestinal symptoms in IBS patients. METHODS: A double-blind, placebo-controlled trial was performed. Adults meeting IBS Rome III criteria with ≥3 pain attacks per month were randomised to pregabalin 225 mg vs placebo twice daily for 12 weeks. Questionnaires were completed weekly. The prim...
13 CitationsSource
Summary Background Hypnotherapy for irritable bowel syndrome (IBS) has been used primarily in patients with refractory symptoms in specialised departments and delivered on an individual basis. We aimed to test the hypothesis that hypnotherapy would be more effective than educational supportive therapy, and that group hypnotherapy would be non-inferior to individual hypnotherapy for patients with IBS referred from primary and secondary care. Methods We did a multicentre randomised controlled tria...
30 CitationsSource
#1Alexander C. Ford (University of Leeds)H-Index: 86
#2Brian E. Lacy (Mayo Clinic)H-Index: 54
Last. Paul Moayyedi (McMaster University)H-Index: 115
view all 5 authors...
Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain–gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective. We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidep...
135 CitationsSource
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 6 authors...
Background & Aims Several secretagogues have been approved for the treatment of irritable bowel syndrome with constipation (IBS-C). However, their relative efficacy is unclear because there have been no head-to-head randomized controlled trials. We conducted a network meta-analysis to compare their efficacies in patients with IBS-C. Methods We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane Central Register of Controlled Trials through June 2018 to identify randomized controlled trial...
68 CitationsSource
Cited By33
#1Christopher J Black (University of Leeds)H-Index: 13
#2Heidi M Staudacher (Deakin University)H-Index: 20
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 3 authors...
Objective null A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best com...
#1Wade Billings (IU: Indiana University)
#2Karan Mathur (IU: Indiana University)H-Index: 1
Last. Andrea Shin (IU: Indiana University)H-Index: 20
view all 5 authors...
Background & Aims Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS. Methods Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates o...
1 CitationsSource
#1Philip Austin (Greenwich Hospital)H-Index: 8
OBJECTIVE Although virtual reality VR is shown to have short-term analgesic effects in acute pain settings, its long-term efficacy with chronic pain conditions has not been established. This scoping review aims to provide a summary of VR approaches explored in chronic primary and secondary pain conditions as defined by the International Association for the Study of Pain. METHODS A systematic literature search in Ovid PubMed and Ovid Embase was conducted between January 5-10th 2021 using the Arks...
Irritable bowel syndrome is one of the most common functional bowel disorders, and has a substantial impact on patients' daily lives, as well as a big economic impact on society. It is characterised by abdominal pain, bloating and abdominal distention and altered bowel movements, with a predominance of diarrhoea, constipation, or alternation of these signs, which cannot be explained by a structural or biochemical abnormality. Its aetiopathogenesis and pathophysiological mechanism are unknown. Th...
Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction which can have a considerable impact on quality of life. Following diagnosis, timely and evidence-based management is vital to the care of patients with IBS, aiming to improve outcomes, and enhance patient satisfaction. Good communication is paramount, and clinicians should provide a clear explanation about the disorder, with a focus on exploring the patient’s own beliefs about IBS, and a discussion of any concerns they...
#1Christina H. Jagielski (UM: University of Michigan)H-Index: 5
Last. Megan E. RiehlH-Index: 8
view all 2 authors...
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that is associated with significant physical, emotional, and occupational burden. Factors such as early life stress, sleep disruption, maladaptive coping strategies, symptom hypervigilance, and visceral hypersensitivity negatively affect gut-brain communication and increase the likelihood of developing IBS or worsen IBS severity. Behavioral strategies, such as cognitive behavioral therapy, gut-directed hypnosis, and min...
#1Edith Pérez de Arce (University of Chile)H-Index: 2
#2Rodrigo Quera (University of Los Andes)H-Index: 1
Last. Eamonn Martin Quigley (Cornell University)H-Index: 120
view all 3 authors...
Irritable bowel syndrome and inflammatory bowel disease differ in their natural evolution, etiopathogenesis, diagnostic criteria, and therapeutic approach. However, recent evidence has suggested some similarities in mechanisms underlying symptom development and progression. There is a relevant role for alterations in the microbiome-brain-gut axis in both diseases. The presence of irritable bowel syndrome symptoms in patients with quiescent inflammatory bowel disease is common in clinical practic...
#1David M. Rodrigues (Queen's University)H-Index: 1
#2Douglas Motomura (Queen's University)
Last. Michael Beyak (Queen's University)H-Index: 14
view all 4 authors...
BACKGROUND AND AIM Functional dyspepsia (FD) is a common gastrointestinal disorder, characterized primarily by postprandial fullness or early satiety and/or pain in the epigastrium with no endoscopic evidence of disease. Psychological therapies have been adapted to the treatment of disordered gut-brain interaction such as FD. We sought to determine if psychological interventions were efficacious in providing symptom management and improving health-related quality of life in patients suffering fr...
1 CitationsSource
#1Heidi M Staudacher (Deakin University)H-Index: 20
#2Antonina Mikocka-Walus (Deakin University)H-Index: 29
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 3 authors...
Summary The frequent co-occurrence of irritable bowel syndrome and the common mental disorders of anxiety and depression is well established. A range of biological and psychosocial disease mechanisms are common to both disorders, many of which contribute to a dysregulated gut–brain axis. Clinical and subthreshold psychological comorbidity adds to the functional impairment and disease burden in individuals with irritable bowel syndrome. Progress is being made with regard to understanding irritabl...
2 CitationsSource