Hypnotherapy, antidepressants and other mind-centered treatments could help people battling severe irritable bowel syndrome, a British survey of the literature finds.
Such treatments are effective because "people who have irritable bowel syndrome (IBS) don't necessarily have a clinical disorder in terms of psychology but have certain behavior patterns that make them vulnerable to symptoms," explained Bu'Hussain Hayee, a clinical research fellow at University College Hospital in London.
He and Dr. Ian Forgacs, a consulting gastroenterologist at Kings College Hospital, compiled the survey, published in the May 26 British Medical Journal, as a working guide for physicians.
"In part, the symptoms of irritable bowel syndrome are similar to those you find in depression, so things that work for depression work for it," Hayee said. Patients with IBS "are not depressed," he said, "but the treatments work."
Symptoms of the condition can include cramping, bloating, constipation and diarrhea. The condition is surprisingly common. The U.S. National Institute of Diabetes and Digestive and Kidney Disease estimates that as many as 1 in 5 adult Americans will suffer one or more symptoms of IBS at some time in their lives. Most people can control symptoms with diet, medications and stress management.
One common stress-management technique successfully used in IBS is cognitive behavioral therapy, Hayee said. That's a general term for a set of psychotherapies based on the belief that changing the way a person thinks about a condition can bring about improvement, even if the condition does not change.
"It has proven to be effective," Hayee said. "It focuses on the patient's perception of symptoms rather than on the symptoms themselves." Studies have shown that cognitive behavior therapy is as effective in IBS as antidepressant medication, and that its effects last longer, he said.
Hypnotherapy has also proven effective in small trials, although a recent review found insufficient evidence to recommend its widespread use, Hayee said.
In a condition with such a wide range of symptoms, treatment must be tailored to the individual patient, he said. "In general, people who are more open to the idea of therapy will do better," Hayee said.
IBS is a case of "brain-gut interaction," added Dr. Sita Chokhavatia, a professor of medicine in the gastroenterology department of Mount Sinai Medical Center in New York City, who specializes in treating the condition.
"There is a 'big brain' in the skull and a 'little brain' in the enteric [intestinal] tract," she said. "Either you have too much information going up or too much information going down."
Treatment requires doctor-patient discussion in a psychiatric setting, Chokhavatia said. "You discuss it with patients -- not so much as a psychological disease per se but as a brain-gut reaction, so the patient can sense less pain."
The focus must be on the symptoms felt by a specific patient, she said. "Cognitive behavioral therapy has been used more in patients with constipation, where it has been shown to be successful in some studies," Chokhavatia said.
Talks between doctor and patient are used to establish levels of anxiety and stress felt by individuals, she said. If stress levels are high, hypnotherapy might be offered, "like people trying to stop smoking," Chokhavatia said.
The official government one-in-five estimate for IBS incidence might be low, she added, "Lots of people don't complain," Chokhavatia said. "They feel symptoms but don't come to the doctor."
Those who do seek help have a reasonable chance of getting it under control, in terms of gaining a better quality of life, she said.
More information
Causes, symptoms and treatments for IBS are described by the U.S. National Digestive Diseases Information Clearinghouse.
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