Crohns Colitis. 2020 Nov 27;jjaa241. doi: 10.1093/ecco-jcc/jjaa241. Online ahead of print.

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.

• PMID: 33245332

• DOI: 10.1093/ecco-jcc/jjaa241

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 versus standard medical treatment (SMT) for IBS-type symptoms in IBD patients.

Methods: In this multicenter, randomized, controlled, open label trial, patients aged 12-65 years with IBD in clinical remission (global assessment) and biochemical remission (fecal 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 analogue 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 9 (27%) of 33 patients randomized to SMT and 9 (30%) of 30 patients randomized to hypnotherapy (p=0.81). Adequate relief was reported in respectively 60% and 40% of subjects. Exploratory analyses of secondary outcomes revealed no apparent differences between both treatment groups.

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