section name header

Evidence summaries

Psychological Treatments for Irritable Bowel Syndrome

Psychological treatments may have some short-term effect for irritable bowel syndrome. Level of evidence: "C"

A Cochrane review [Abstract] 1 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).

References

  • 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. [PubMed].

Primary/Secondary Keywords