Effect of Brain-gut Behavioral Treatments on Abdominal Pain in Irritable Bowel Syndrome: Systematic Review and Network Meta-analysis Gastroenterology. 2024 May20:S00165085(24)049321. doi:10.1053/j.gastro.2024.05.010.Online ahead of print.
Vivek C Goodoory 1, Mais Khasawneh 1, Elyse R Thakur 2, Hazel A Everitt 3, Gregory D Gudleski 4, Jeffrey M Lackner 4, Rona Moss-Morris 5, Magnus Simren 6, Dipesh H Vasant 7, Paul Moayyedi 8, Christopher J Black 1, Alexander C Ford 9 |
Author information 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. 2Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA. 3Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK. 4Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. 5Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 6Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 7Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK. 8Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 9Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com. 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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