Review Article: Gut-Directed Hypnotherapy in the Management of Irritable Bowel Syndrome and Inflammatory Bowel Disease

Aliment Pharmacol Ther. 2015 Jun;41(11):1104-15. doi: 10.1111/apt.13202. Epub 2015 Apr 10.

Abstract

Background: Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD).

Aim: To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD.

Methods: A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed.

Results: Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P < 0.05) in overall gastrointestinal symptoms following treatment usually compared to supportive therapy only. Response rates amongst those who received gut-directed hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials.

Conclusions: Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Brain / metabolism
  • Colitis, Ulcerative / psychology
  • Colitis, Ulcerative / therapy
  • Combined Modality Therapy
  • Humans
  • Hypnosis / methods*
  • Inflammatory Bowel Diseases / psychology
  • Inflammatory Bowel Diseases / therapy*
  • Irritable Bowel Syndrome / psychology
  • Irritable Bowel Syndrome / therapy*