Management of Stress in Inflammatory Bowel Disease: A Therapeutic Option?

James R Goodhand; Mahmood Wahed; David S Rampton

Disclosures

Expert Rev Gastroenterol Hepatol. 2009;3(6):661-79. 

In This Article

Hypnotherapy

Hypnotherapy is a technique by which a practitioner induces a temporary trance-like state in patients. In relation to its use to date in IBD and IBS (see later), the practitioner then uses suggestion to induce relaxation as well as beneficial modification of the way in which the patient experiences the gut working. Hypnotherapy has been used successfully for many years as a treatment for psychological disorders. It has also been used in a variety of medical diseases which are believed to be worsened by stress, including hypertension, asthma, eczema and psoriasis.[115–119] In gastrointestinal disease, hypnosis was first shown to be effective in patients with refractory IBS[120] and later in functional dyspepsia. In the prevention of duodenal ulceration[121] as well as noncardiac chest pain.[122,123] In acute studies, hypnosis has been shown to reduce both concentrations of inflammatory mediators in the blood and their release from rectal mucosa.[124]

There are anecdotal reports, but limited formal data, of the benefit of hypnotherapy in patients with IBD. In one unblinded study of 12 patients with active UC and CD, after 6 weeks of gut-focused hypnotherapy, there was a nonsignificant trend to improvement in IBDQ scores.[125] More recently, similar findings were reported in eight women with inactive IBD, in whom there was significant improvement in IBDQ scores.[126] Furthermore, a study of 15 IBD patients with either severe disease or disease refractory to corticosteroids received 12 sessions of gut-focused hypnotherapy and were followed up for a mean of 5 years.[127] Two of the 15 failed to respond to hypnotherapy and required surgery. Of the remaining 13, four were in remission, eight had mildly severe and one had moderately severe disease at the end of the study; improvements in quality of life were seen in 12 patients and most patients managed to stop corticosteroids. These small uncontrolled reports emphasize the need for controlled studies of the efficacy of hypnotherapy in IBD.

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