The Effectiveness of Hypnotherapy in the Management of Irritable Bowel Syndrome

S. Wilson; T. Maddison; L. Roberts; S. Greenfield; S. Singh

Disclosures

Aliment Pharmacol Ther. 2006;24(5):769-780. 

In This Article

Summary and Introduction

Summary

Aim: To systematically review the literature evaluating hypnotherapy in the management of irritable bowel syndrome (IBS).
Methods: Electronic databases were searched (Cochrane Library, Medline, CINAHL, AMED, Embase, PsycINFO, CISCOM, TRIP and the Social Science Citation index), bibliographic references scanned and main authors contacted. No restrictions were placed on language or publication year. Eligible studies involved adults with IBS using single-component hypnotherapy. All studies, except single case or expert opinion, were sought and all patient-related outcomes eligible.
Results: Out of 299 unique references identified, 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series were eligible. These tended to demonstrate hypnotherapy as being effective in the management of IBS. Numbers of patients included were small. Only one trial scored more than four out of eight on internal validity.
Conclusion: The published evidence suggests that hypnotherapy is effective in the management of IBS. Over half of the trials (10 of 18) indicated a significant benefit. A randomized placebo-controlled trial of high internal validity is necessary to establish the effectiveness of hypnotherapy in the management of IBS. Until such a trial is undertaken, this form of treatment should be restricted to specialist centres caring for the more severe forms of the disorder.

Introduction

Irritable bowel syndrome (IBS) is a chronic disorder affecting 10-20% of the population.[1,2] It is estimated that a general practitioner in the UK sees eight patients with IBS every week[3] and these patients constitute up to 50% of gastroenterology referrals.[4,5,6,7] The quality of life (QOL) of patients with IBS is surprisingly poor, particularly in the population seeking professional health care,[8] with over 40% of those referred to hospital out-patients reporting avoidance of some activities[9] and some studies have indicated that the impact of IBS on QOL is as great as that observed for congestive heart failure[10] and stroke.[11] Health service costs, both direct[12,13] and indirect,[14,15,16] are high.

Conventional therapy leaves up to 25% of sufferers without relief of symptoms[17] and many patients have been reported to turn to alternative therapies.[18]'Gut-directed hypnotherapy' (GDH), a type of hypnosis, is one of the alternative therapies most frequently reported to have a demonstrable beneficial therapeutic impact on IBS symptoms.[19,20] GDH is based on the use of hypnotic induction, using progressive relaxation and other techniques, followed by imagery directed towards control and normalization of gut function.[20] Therapy also aims to teach autohypnosis, to enable patients to manage their own symptoms without ongoing reliance on primary or secondary care, although occasional refresher sessions may be required.

The first paper to report an evaluation of GDH in the management of IBS was published 20 years ago[20] and indicated a significant benefit over placebo, in patients referred to a specialist centre for the management of refractory IBS. A more recent audit of patients treated in this hypnotherapy unit, reported that GDH may also confer longer term benefits and reduced health care costs as a result of lower consultation rates and medication use.[21] Such studies suggest benefits would be achieved by the more widespread use of GDH in the management of IBS.

Four reviews of the published evidence relating to the role of hypnotherapy in the management of IBS have been previously published with conflicting conclusions.[22,23,24,25] The first review[24] concluded that hypnotherapy was effective in the management of refractory IBS, with suggested models of implementation focusing on the training of primary and community care staff (nurses, physiotherapists and occupational therapists). However, this review limited searches to only one database (CISCOM) and no detail was provided with respect to the search strategy or years searched, how inclusion criteria were applied, how judgements of validity were made or the process of data extraction. Spanier's review aimed to determine the effectiveness of alternative therapies,[25] including hypnotherapy, for the treatment of IBS but was also limited to only one bibliographic database (Medline) and excluded all non-English language studies; language restrictions may compromise the validity of a systematic review, but potentially more so in the areas of alternative therapy where major developments have occurred outside of the English speaking world.[26] This review concluded that the studies identified (n = 3) were of poor quality and further research was necessary to determine the efficacy of hypnotherapy. Two recent reviews have included differing studies; Tan et al.[22] included six controlled trials and concluded that hypnosis consistently produces significant results, and, Whitehead[23] included five controlled studies and concluded that hypnosis has a substantial therapeutic impact on IBS.

The number of primary studies and reviews suggesting that GDH may have significant value in the management of IBS and the lack of a high quality systematic review, provided the impetus to conduct this systematic review, which addresses the question of whether hypnotherapy is effective in the management of IBS.

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