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Hypnotherapy for treatment of irritable bowel syndrome

  • Review
  • Intervention

Authors

  • Annette N Webb,

    Corresponding author
    1. Royal Children's Hospital Melbourne, Department of Gastroenterology and Clinical Nutrition, Melbourne, Australia
    • Annette N Webb, Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital Melbourne, Flemington Road, Parkville Victoria 3052, Melbourne, Australia. annette.webb@rch.org.au.

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  • Renata Kukuruzovic,

    1. Unversity of Melbourne,, Senior Lecturer, Department of Paediatrics,, Melbourne, Victoria, Australia
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  • Anthony G Catto-Smith,

    1. Royal Children's Hospital Melbourne, Department of Gastroenterology and Clinical Nutrition, Melbourne, Australia
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  • Susan M Sawyer

    1. Royal Children's Hospital Melbourne, Centre for Adolescent Health, Melbourne, Victoria, Australia
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Abstract

Background

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms.

Objectives

To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome.

Search methods

Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched.

Selection criteria

Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention.

Data collection and analysis

All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient's overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events.

Main results

Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic effect of hypnotherapy was found to be superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy. Harmful side-effects were not reported in any of the trials. However, the results of these studies should be interpreted with caution due to poor methodological quality and small size.

Authors' conclusions

The quality of the included trials was inadequate to allow any conclusion about the efficacy of hypnotherapy for irritable bowel syndrome. More research with high quality trials is needed.

摘要

背景

催眠療法應用於腸躁症

腸躁症(Irritable bowel syndrome IBS) 是一種常見的功能性胃腸疾病,原因仍然不明。目前藥物治療的效果有限,而催眠療法已有報告顯示對腸躁症是有效益的。

目標

評估催眠療法治療腸躁症的效果。

搜尋策略

經有系統地搜尋MEDLINE(1966年至2006年3月)、EMBASE(1980年至2006年3月)、PsycINFO(1806年至2006年3月) 、CINAHL(Cumulative Index to Nursing and Allied Health Literature,1982年至2006年3月)、AMED Complementary Medicine Database, 1985年至2006年3月)、以及Cochrane Central Register of Controlled trials. Digestive Disease Week 研討會摘要集(1980年至2005年)來找出已發表和未發表的隨機對照臨床試驗和半隨機對照臨床試驗。

選擇標準

符合資格的研究包括:所有比較腸躁症患者接受催眠療法與不治療或給另一種治療的隨機和準隨機對照臨床試驗。

資料收集與分析

所有研究先被評估是否符合被列入的資格。符合的研究由四位作者各別摘錄並分析其品質和數據。主要衡量目標是綜合腹痛、腹瀉或便秘和腸胃脹氣的整體腸道症狀嚴重程度評分。次要目標包括腹痛、腹瀉、便秘、腸胃脹氣、生活品質、病患健康的整體評估、心理評估(正如每份有效的問卷調查表)和不良的事件。

主要結論

4個研究共147位病患符合收案條件。只有1個研究以催眠療法和其他替代療法(心理治療和安慰劑)作比較,另2個研究比較催眠療法和等待名單對照組,最後一個研究以催眠療法與常用療法比較。由於不同的結果分析方式和研究設計,所以不能匯集這些數據來做統合分析(metaanalysis)。對於那些在短期內使用慣用藥物治療腹痛及綜合型主要腸躁症症狀失敗的病患,催眠治療的效果是優於等待名單控制組(waitinglist controls)和常用的醫療處置。在這些臨床試驗中並未發現不良的副作用。然而,由於這些研究方法的品質不良和規模較小,所以在解釋這些研究結果時應特別謹慎。

作者結論

目前這些被討論的臨床試驗對於催眠療法應用於腸躁症的治療效果是不足以下任何結論的。更多精心設計的研究是需要的。

翻譯人

本摘要由臺中榮民總醫院葉惠英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前用催眠療法治療腸躁症的效果是不確定的,目前雖然有一些探討以催眠療法治療腸躁症的研究,但只有少數的研究被呈現而且其研究方法未達高標準。由專家比較分析催眠療法、常規療法、支持性的心理治療(症狀的討論、造成情緒問題的原因和壓力性的生活事件)和未給予任何治療的等待名單控制(waitinglist controls)應用於治療腸躁症的效果。什麼是腸躁症?以催眠療法來治療腸躁症有效嗎? 腸躁症是一種常見的胃腸疾病,其特徵包括慢性腹痛和腸蠕動異常(即腹瀉,便秘或兩者交替發生) 。當腹痛發生或腸蠕動異常時,藉由催眠療法可能影響部份腦神經傳導物質產生變化而緩解腸躁症的症狀。這些研究顯示了什麼呢?該研究提供了一些證據支持催眠療法在治療腸躁症症狀(包括腹痛)是有幫助的。然而,由於這些研究的品質有限和規模較小,所以在解釋這些研究結果時應特別謹慎。催眠療法的安全性如何?在該研究中催眠療法有很好的耐受性,並沒有嚴重副作用的報告。催眠療法治療腸躁症的效果如何?雖然目前的研究數據是有希望的,但對於催眠療法應用於腸躁症的治療效果是沒有足夠的證據下任何結論的。未來需要更多設計的良好研究。

Plain language summary

Hypnotherapy (treatment by hypnosis) for the treatment of irritable bowel syndrome

Studies of hypnotherapy for treatment of IBS.
Only a small number of studies of hypnotherapy have been performed and the way these studies were carried out was not up to a high standard. Hypnotherapy was either compared with standard treatment of IBS, with supportive psychotherapy (discussion of symptoms and possible contributing emotional problems and stressful life events) or with no treatment in patients on a waiting list to be seen by a specialist.

What is IBS and could hypnotherapy work as treatment?
IBS is a common gastrointestinal disorder characterized by chronic abdominal pain and an abnormal pattern of bowel movements (i.e. diarrhea, constipation or mixed diarrhea and constipation). Hypnotherapy could provide benefit for IBS, by affecting parts of the brain that experience abdominal pain or influence the movement of the bowel.

What did the studies show?
The studies provide some evidence that suggests that hypnotherapy might be effective in treating IBS symptoms including abdominal pain. However the results of these studies should be interpreted with caution due to poor study quality and small size.

How safe is hypnotherapy?
Hypnotherapy was well tolerated and no serious side effects were reported in the studies.

What is the bottom line?
Although current data are promising, there is insufficient evidence to allow any conclusion about the effectiveness of hypnotherapy for the treatment of IBS. More research with well designed studies is needed.

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