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:
- 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.
