Slouha Ethan, Mohamed Ahmed, Patel Bansari, Razeq Ziyad, Clunes Lucy A, Kollias Theofanis F
Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD.
Pharmacology, St. George's University School of Medicine, St. George's, GRD.
Cureus. 2024 Feb 13;16(2):e54138. doi: 10.7759/cureus.54138. eCollection 2024 Feb.
Irritable bowel syndrome (IBS) is a common yet debilitating and chronic condition that consists of disturbances in bowel habits and abdominal pain that is frequently relieved with defecation. While the first line of treatment for IBS is pharmacological treatment, this has been shown to fail, leading to the patient being classified as having refractory IBS. The quality of life (QOL) of these patients is greatly hindered; in this case, there are rarely moments of relief. Additional modalities of treatment have been employed in classical cases of IBS, such as psychotherapy, and research has started to evaluate its effectiveness with refractory IBS. Both cognitive behavioral therapy (CBT) and gut-directed hypnotherapy (GDH) are effective in treating classical IBS as they restructure and bring a state of meditation to the patient, allowing them to work through the symptoms. The question is whether it remains successful in refractory cases. This systematic review was conducted with strict adherence to PRISMA guidelines with an initial inquiry resulting in 28,978 publications through PubMed, ScienceDirect, and ProQuest databases. Through automatic and manual screening processes, articles that were peer-reviewed experimental or observation publications done between 2003 and 2023 were included in this study, resulting in 21 publications. Across all studies evaluating CBT, it was consistently found to be successful in improving symptom severity and frequency, QOL, and extracolonic symptoms such as anxiety and depression. When broken down into delivery methods, minimal contact CBT was found to be just as, if not superior, to standard contact. Within this, telephone-delivered CBT was superior to web-delivered CBT. GDH and biofeedback therapy were found to also significantly improve all domains of IBS with no difference between them. Acceptance and commitment therapy were found only to improve associated symptoms. However, there was no significant improvement in their QOL, whereas integrative group therapy found no significant improvement in any domain. Because IBS is so common and crippling to those affected, its crucial to continuously improve QOL through advancement in treatment modalities. Further research should focus more on other modes of therapy as success has been shown in standard therapeutic techniques.
肠易激综合征（IBS）是一种常见但使人衰弱的慢性疾病，其特征为排便习惯紊乱和腹痛，排便后腹痛常可缓解。虽然IBS的一线治疗方法是药物治疗，但已证明这种方法无效，导致患者被归类为难治性IBS。这些患者的生活质量（QOL）受到极大影响；在这种情况下，很少有缓解的时候。在IBS的经典病例中已采用了其他治疗方式，如心理治疗，并且研究已开始评估其对难治性IBS的有效性。认知行为疗法（CBT）和肠道定向催眠疗法（GDH）在治疗经典IBS方面均有效，因为它们能重塑患者并使其进入冥想状态，从而使他们能够应对症状。问题在于它在难治性病例中是否仍然有效。本系统评价严格遵循PRISMA指南进行，初步检索通过PubMed、ScienceDirect和ProQuest数据库共得到28978篇出版物。通过自动和手动筛选过程，本研究纳入了2003年至2023年期间经过同行评审的实验性或观察性出版物，最终得到21篇出版物。在所有评估CBT的研究中，一致发现它在改善症状严重程度和频率、生活质量以及焦虑和抑郁等结肠外症状方面是成功的。按治疗方式细分，发现最低限度接触式CBT即便不比标准接触式更好，至少也一样有效。在此范围内，电话提供的CBT优于网络提供的CBT。发现GDH和生物反馈疗法也能显著改善IBS的所有方面，且二者之间无差异。发现接受与承诺疗法仅能改善相关症状。然而，它们的生活质量没有显著改善，而综合团体疗法在任何方面均未发现显著改善。由于IBS非常常见且对患者造成严重影响，通过改进治疗方式持续提高生活质量至关重要。鉴于标准治疗技术已显示出成功，进一步的研究应更多地关注其他治疗模式。
