BMJ

Mind-body therapies for irritable bowel syndrome

January 2, 2025

Guidelines from multiple organizations support psychological- and behavior-based interventions, with caveats regarding patient selection and place in therapy.

Brain-gut behavior interventions

ACG guidelines conditionally recommend that such interventions can be used to treat global IBS symptoms for patients who do not have severe psychiatric comorbidities, but this is based on low quality evidence.

• Cognitive behavioral therapy (CBT). RCTs have shown benefit for group CBT compared with waitlist controls in drug refractory IBS, and both group and individually nurse administered gut-directed hypnotherapy were effective at improving IBS symptoms, psychological symptoms, and quality of life for patients with IBS.
• Self-management training programs target self-efficacy and have been shown to have a positive impact on IBS health outcomes.
• Digitally delivered psychologically based therapies. Overall, these alternative delivery methods improve patient access and allow additional care options with similar patient outcomes, but evidence quality is still low.

Mind-body interventions

• Exercise has been shown to improve IBS symptoms through a variety of mechanisms with potential long-term durability (>5 years). A systematic review of 14 RCTs (n = 683) showed statistically significant benefit for patients with IBS across a variety of aerobic and static activity, but studies had significant bias. A Cochrane review (11 RCTs, n = 622) of physical activity including yoga, treadmill exercise, or generalized support to increase physical activity for the treatment of IBS concluded that physical activity might improve symptoms but not quality of life or abdominal pain, with the quality of evidence deemed very low. British Society of Gastroenterology guidelines strongly recommend regular exercise as a first line treatment for global IBS symptoms (weak quality evidence).
• Meditative movement (yoga/qi gong). A systematic review of six RCTs of yoga for IBS found yoga to be more beneficial than conventional care, with statistically significant decreases in bowel symptoms, IBS symptom severity, and anxiety with improvements in quality of life, global symptoms, and physical functioning. No statistically significant differences were found between yoga and exercise. Virtual yoga programs were also shown in RCTs to be safe and feasible, with positive impacts on IBS symptom severity from baseline to follow-up in the yoga group but not in the advice-only control group. There were no statistically significant differences between groups in symptom severity, but statistically significant improvements were seen for quality of life, fatigue, and perceived stress in the yoga group compared with control. A virtual tai chi program was piloted for IBS-C patients in one single-arm trial and was found to be feasible, with high satisfaction among completers, and statistically significant improvement in symptom severity from baseline to follow-up; further studies are needed to draw conclusions.

Physical/manual manipulations and biofeedback

• Osteopathic manipulation. A 2014 systematic review evaluated five studies (n = 204) utilizing osteopathic manipulation for IBS, finding pronounced short term benefits in IBS symptoms compared with sham or standard of care. Like acupuncture, studies of osteopathic manipulation utilize varied, individualized approaches, and lack standardized symptom severity or secondary outcome measures, making findings difficult to generalize and interpret. Except for a small RCT on micro-physiotherapy which showed improvement in IBS over sham, other manual therapies have evidence in comorbid pain conditions such as fibromyalgia but not in IBS.
• Biofeedback. A Cochrane review found high or unclear risk of bias in all studies with overall uncertain benefit of biofeedback for IBS symptoms. Further studies are required to understand which modality has benefit in IBS treatment.

Source:

Wang XJ, et al. (2024, December 16). BMJ. Non-pharmaceutical treatments for irritable bowel syndrome.
https://pubmed.ncbi.nlm.nih.gov/39681399/