Psychological treatments for irritable bowel syndrome

Psychological treatments may have some short-term effect for irritable bowel syndrome.

A Cochrane review included 25 studies with a total of 1 858 subjects (mean age range 31–49 years). Treatment duration and follow up time varied from 6 weeks to 12 months.

• Psychological interventions as a group
  • Symptom score improvement at 2 and 3 months: standardized mean difference (SMD) 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively compared to usual care, SMD 0.71 (95% CI 0.08 to 1.33) and –0.17 (95% CI –0.45 to 0.11) respectively against placebo (5 studies)
  • Improvement of abdominal pain: SMDs at 2 and 3 months 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care, SMD at 3 months 0.31 (95% CI –0.16 to 0.79) against placebo
  • Improvement in quality of life: SMD from usual care at 2 and 3 months 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI –0.16 to 0.77) respectively
• Cognitive behavioural therapy
  • Symptom score improvement at 2 and 3 months: SMD 0.75 (95% CI –0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care, SMD 0.68 (95% CI –0.01 to 1.36) and –0.17 (95% CI –0.45 to 0.11) respectively against placebo
  • Improvement of abdominal pain: SMD at 2 and 3 months 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI –0.04 to 0.49) compared to usual care, SMD at 3 months 0.33 (95% CI –0.16 to 0.82) against placebo
  • Improvement in quality of life: SMD at 2 and 3 months compared to usual care 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively
• Interpersonal psychotherapy
  • Relative risk (RR) for adequate relief of symptoms: 2.02 (95% CI 1.13 to 3.62), risk difference (RD) 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual
  • Improvement of symptom score: SMD 0.35 (95% CI –0.75 to 0.05) compared with usual care
• Relaxation/Stress management
  • Symptom score improvement: SMD at 2 months 0.50 (95% CI 0.02 to 0.98) compared with usual care
  • Improvement of abdominal pain: SMD at 3 months 0.02 (95% CI –0.56 to 0.61) compared with usual care
• Long term results
  • Very few long term follow-up results were available. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality.

Comment: The quality of evidence is downgraded by study quality (poor quality of the original studies) and by inconsistency (heterogeneity in interventions and outcomes, variability in results across studies).

Ədəbiyyat

1. Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev 2009;(1):CD006442. .