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Effect of brain-gut behavioral treatments on abdominal pain in irritable bowel syndrome: systematic review and network meta-analysis

Effect of brain-gut behavioral treatments on abdominal pain in irritable bowel syndrome: systematic review and network meta-analysis
Effect of brain-gut behavioral treatments on abdominal pain in irritable bowel syndrome: systematic review and network meta-analysis
Background and aims: some brain-gut behavioral treatments (BGBTs) are beneficial for global symptoms in irritable bowel syndrome (IBS). US management guidelines suggest their use in patients with persistent abdominal pain but their specific effect on this symptom has not been assessed systematically.

Methods: we searched the literature through 16th December 2023 for randomized controlled trials (RCTs) assessing efficacy of BGBTs for adults with IBS, compared with each other, or a control intervention. Trials provided an assessment of abdominal pain resolution or improvement at treatment completion. We extracted data as intention-to-treat analyses, assuming dropouts to be treatment failures and reporting pooled relative risks (RRs) of abdominal pain not improving with 95% confidence intervals (CIs), ranking therapies according to P-score.

Results: we identified 42 eligible RCTs, containing 5220 participants. After treatment completion, the BGBTs with the largest numbers of trials, and patients recruited, demonstrating efficacy for abdominal pain, specifically, included self-guided/minimal contact cognitive behavioral therapy (CBT) (RR = 0.71; 95% CI 0.54-0.95, P-score 0.58), face-to-face multicomponent behavioral therapy (RR = 0.72; 95% CI 0.54-0.97, P score 0.56), and face-to-face gut-directed hypnotherapy (RR = 0.77; 95% CI 0.61-0.96, P-score 0.49). Among trials recruiting only patients with refractory global IBS symptoms, group CBT was more efficacious than routine care for abdominal pain, but no other significant differences were detected. No trials were low risk of bias across all domains and there was evidence of funnel plot asymmetry.

Conclusions: several BGBTs, including self-guided/minimal contact CBT, face-to-face multicomponent behavioral therapy, and face-to-face gut-directed hypnotherapy may be efficacious for abdominal pain in IBS, although none were superior to another.
Abdominal Pain, Cognitive Behavior Therapy, Evidence-Based Practice, Hypnosis
0016-5085
934-943.e5
Goodoory, Vivek C.
bd6303a6-334d-4cd5-82c1-53c41f1d3bd0
Khasawneh, Mais
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Thakur, Elyse R.
1a576ec8-fd5e-44a6-b342-e69ae49d189f
Everitt, Hazel A.
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Gudleski, Gregory D.
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Lackner, Jeffrey M.
acd22a46-3a43-4c50-80be-3fd80f29fb1b
Moss-Morris, Rona
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Simrén, Magnus
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Vasant, Dipesh H.
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Moayyedi, Paul
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Black, Christopher J.
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Ford, Alexander C.
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Goodoory, Vivek C.
bd6303a6-334d-4cd5-82c1-53c41f1d3bd0
Khasawneh, Mais
3c26529b-c8d9-4bb1-a8f5-98803c92c649
Thakur, Elyse R.
1a576ec8-fd5e-44a6-b342-e69ae49d189f
Everitt, Hazel A.
80b9452f-9632-45a8-b017-ceeeee6971ef
Gudleski, Gregory D.
c70d974e-d935-4f9b-ba6e-eda9611820e7
Lackner, Jeffrey M.
acd22a46-3a43-4c50-80be-3fd80f29fb1b
Moss-Morris, Rona
9fd6029f-61b1-4c6d-ae30-025b402c09a8
Simrén, Magnus
66b07733-fc0b-4c2e-bf75-020a1e96b1b9
Vasant, Dipesh H.
2e383188-9738-4a2d-a61a-fd2f11b4841e
Moayyedi, Paul
87084aad-4871-4458-82d5-34e19931fe78
Black, Christopher J.
5cb820b3-b2a9-4725-abc8-b185f55bcc60
Ford, Alexander C.
d18081ef-9517-46a3-96c9-ccc923e40c7f

Goodoory, Vivek C., Khasawneh, Mais, Thakur, Elyse R., Everitt, Hazel A., Gudleski, Gregory D., Lackner, Jeffrey M., Moss-Morris, Rona, Simrén, Magnus, Vasant, Dipesh H., Moayyedi, Paul, Black, Christopher J. and Ford, Alexander C. (2024) Effect of brain-gut behavioral treatments on abdominal pain in irritable bowel syndrome: systematic review and network meta-analysis. Gastroenterology, 167 (5), 934-943.e5. (doi:10.1053/j.gastro.2024.05.010).

Record type: Article

Abstract

Background and aims: some brain-gut behavioral treatments (BGBTs) are beneficial for global symptoms in irritable bowel syndrome (IBS). US management guidelines suggest their use in patients with persistent abdominal pain but their specific effect on this symptom has not been assessed systematically.

Methods: we searched the literature through 16th December 2023 for randomized controlled trials (RCTs) assessing efficacy of BGBTs for adults with IBS, compared with each other, or a control intervention. Trials provided an assessment of abdominal pain resolution or improvement at treatment completion. We extracted data as intention-to-treat analyses, assuming dropouts to be treatment failures and reporting pooled relative risks (RRs) of abdominal pain not improving with 95% confidence intervals (CIs), ranking therapies according to P-score.

Results: we identified 42 eligible RCTs, containing 5220 participants. After treatment completion, the BGBTs with the largest numbers of trials, and patients recruited, demonstrating efficacy for abdominal pain, specifically, included self-guided/minimal contact cognitive behavioral therapy (CBT) (RR = 0.71; 95% CI 0.54-0.95, P-score 0.58), face-to-face multicomponent behavioral therapy (RR = 0.72; 95% CI 0.54-0.97, P score 0.56), and face-to-face gut-directed hypnotherapy (RR = 0.77; 95% CI 0.61-0.96, P-score 0.49). Among trials recruiting only patients with refractory global IBS symptoms, group CBT was more efficacious than routine care for abdominal pain, but no other significant differences were detected. No trials were low risk of bias across all domains and there was evidence of funnel plot asymmetry.

Conclusions: several BGBTs, including self-guided/minimal contact CBT, face-to-face multicomponent behavioral therapy, and face-to-face gut-directed hypnotherapy may be efficacious for abdominal pain in IBS, although none were superior to another.

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Accepted/In Press date: 9 May 2024
e-pub ahead of print date: 20 May 2024
Published date: 20 May 2024
Keywords: Abdominal Pain, Cognitive Behavior Therapy, Evidence-Based Practice, Hypnosis

Identifiers

Local EPrints ID: 490254
URI: http://eprints.soton.ac.uk/id/eprint/490254
ISSN: 0016-5085
PURE UUID: c9b19781-249a-4e64-bdc6-c6603c9bbfd2
ORCID for Hazel A. Everitt: ORCID iD orcid.org/0000-0001-7362-8403

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Date deposited: 21 May 2024 16:48
Last modified: 12 Sep 2024 01:37

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Contributors

Author: Vivek C. Goodoory
Author: Mais Khasawneh
Author: Elyse R. Thakur
Author: Gregory D. Gudleski
Author: Jeffrey M. Lackner
Author: Rona Moss-Morris
Author: Magnus Simrén
Author: Dipesh H. Vasant
Author: Paul Moayyedi
Author: Christopher J. Black
Author: Alexander C. Ford

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