Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndromeand inflammatory bowel disease

Hanlon I1, Hewitt C1, Bell K1, Phillips A2, Mikocka-Walus A1,3. Aliment Pharmacol Ther. 2018 Aug;48(3):244-259. doi: 10.1111/apt.14840. Epub 2018 Jun 14.

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1 Department of Health Sciences, University of York, York, UK.

2 Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK.

3 School of Psychology, Deakin University Geelong, Melbourne, Vic., Australia.


BACKGROUND: Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases.

AIMS: To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases.

METHODS: We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis.

RESULTS: We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD.

CONCLUSION: There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases.

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