A Systematic Review of the Effectiveness of Psychological Treatments for IBS in Gastroenterology Settings: Promising but in Need of Further Study

作者：Thakur Elyse R; Shapiro Jordan; Chan Johanna; Lumley Mark A; Cully Jeffrey A; Bradford Andrea; El Serag Hashem B

来源：Digestive Diseases and Sciences, 2018, 63(9): 2189-2201.

DOI：10.1007/s10620-018-5095-3

• Psychological treatment
• Irritable bowel syndrome
• Gastroenterology clinic settings

Background Psychological treatments are efficacious for irritable bowel syndrome (IBS) in clinical trials; however, their effectiveness when conducted in gastroenterology practice settings is unclear.
Aim To perform a systematic review of the types and effects of psychological treatments for IBS conducted in gastroenterology clinics.
Methods We searched PubMed, EMBASE, and Cochrane central register. Studies conducted in gastroenterology clinic settings with IBS patients who were clinically referred from gastroenterology were included.
Results We identified 3078 citations, of which only eight studies were eligible. Seven studies compared psychological treatments (average n = 25.7; range 12-43) to controls (average n = 25.4 patients; range 12-47), whereas one study compared two active "bonafide" interventions. Psychological treatments varied (cognitive-behavioral therapy, guided affective imagery, mindfulness, hypnosis, biofeedback, emotional awareness training). However, across approaches, short-term benefits were seen. IBS symptoms improved significantly among patients in cognitive and behavioral therapies, mindfulness-based stress reduction, guided affective imagery, and emotional awareness training compared with controls; there was a similar trend for gut-directed hypnotherapy. Similarly, IBS symptoms improved in a study of two active biofeedback and hypnosis treatments.
Conclusions Evidence for the effectiveness of psychological treatment in gastroenterology practice is promising but limited. Study designs that involve a blending of efficacy and effectiveness components are needed.

• 出版日期2018-9