J Crohns Colitis. 2021 Jul 5;15(7):1106-1113. doi: 10.1093/ecco-jcc/jjaa241.

Daniël R Hoekman ¹, Arine M Vlieger ², Pieter C Stokkers ³, Nofel Mahhmod ⁴, Svend Rietdijk ³, Nanne K de Boer ⁵, Tim G de Meij ¹, Carla Frankenhuis ¹, Geert R D'Haens ⁶, Marc A Benninga ¹

Author information

¹Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Center, Amsterdam, The Netherlands.

²Department of Pediatrics, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.

³Department of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

⁴Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.

⁵Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, AG&M Institute, Amsterdam, The Netherlands.

⁶Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

Abstract

Background and aims: Many inflammatory bowel disease [IBD] patients in remission have persisting symptoms, compatible with irritable bowel syndrome [IBS-type symptoms]. We aimed to compare the effectiveness of gut-directed hypnotherapy vs standard medical treatment [SMT] for IBS-type symptoms in IBD patients.

Methods: In this multicentre, randomized, controlled, open-label trial, patients aged 12-65 years with IBD in clinical remission [global assessment] and biochemical remission [faecal calprotectin ≤100 µg/g, or ≤200 µg/g without inflammation at endoscopy] with IBS according to Rome III criteria were randomized to hypnotherapy or SMT. Primary outcome was the proportion with ≥50% reduction on a visual analog scale for symptom severity, as measured with the Irritable Bowel Syndrome Severity Scoring System [IBS-SSS] at week 40 [i.e. 6 months after finishing the intervention], compared to baseline. Secondary outcomes included total IBS-SSS score, quality of life, adequate relief, IBS-related cognitions, and depression and anxiety scores.

Results: Eighty patients were included, of whom 70 received at least one session of the allocated treatment and were included in the modified intention-to-treat-population. Seven patients were excluded because of missing baseline data required for the primary outcome. The primary outcome was met in nine [27%] of 33 patients randomized to SMT and nine [30%] of 30 patients randomized to hypnotherapy [p = 0.81]. Adequate relief was reported in 60% and 40% of subjects, respectively. Exploratory analyses of secondary outcomes revealed no apparent differences between the two treatment groups.

Conclusions: Hypnotherapy was not superior to SMT in the treatment of IBS-type symptoms in IBD patients. Both treatment strategies are reasonable options from a clinical perspective.