Law Mikaela, Pickering Isabella, Bartlett Esme, Sebaratnam Gabrielle, Varghese Chris, Gharibans Armen, O'Grady Greg, Andrews Christopher N, Calder Stefan
The Department of Surgery, The University of Auckland, New Zealand; Alimetry Ltd., Auckland, New Zealand.
Alimetry Ltd., Auckland, New Zealand; The Department of Psychological Medicine, The University of Auckland, New Zealand.
J Psychosom Res. 2023 Dec;175:111516. doi: 10.1016/j.jpsychores.2023.111516. Epub 2023 Oct 10.
Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs.
Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible.
Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later.
This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.
认知行为疗法（CBT）越来越多地用于管理肠-脑互动障碍（DGBIs）。本系统评价旨在综述基于CBT的干预措施对胃十二指肠DGBIs患者有效性的证据。
于2022年7月检索了Medline、Embase、PubMed、Cochrane Central和Scopus数据库。纳入的研究需调查基于CBT的干预措施对胃十二指肠DGBIs患者干预前后胃肠道症状和/或心理结局的影响。排除病例研究、非英文研究以及患者年龄在18岁以下的研究。对结果进行叙述性综合分析，并尽可能计算标准化效应量。
共纳入9项研究（7项随机对照试验和2项前后对照研究），10篇文章报告了相关数据（总样本量N = 602）。这些研究调查了功能性消化不良患者（n = 7）、反刍综合征患者（n = 1）和上腹部嗳气患者（n = 1）。这些研究的干预措施、方法和结局存在异质性，无法进行荟萃分析，且存在中度至高度偏倚风险和高失访率。研究结果表明，从干预前到干预后，胃肠道症状减轻，焦虑、抑郁和生活质量得到改善，症状的效应量为中等至大，心理结局的效应量为小至大。随访至一年后疗效得以维持。
本综述表明有证据支持CBT能有效改善胃十二指肠DGBIs患者的胃肠道症状和心理结局。然而，研究存在异质性、偏倚风险以及缺乏统计报告等问题，表明需要更有力的研究和标准化。
