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David Baxter

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A psychological approach to Irritable Bowel Syndrome management
Fri, May 25 2007

Antidepressants and psychological treatments such as hypnotherapy have the potential to help patients with severe irritable bowel syndrome (IBS), say researchers in this week's BMJ (formerly the British Medical Journal).

IBS is a very common disorder, but conventional 'physical' treatments often do not work very well and patients can feel that their symptoms are being ignored, downplayed or misunderstood.

Patients with IBS are more likely to suffer from anxiety or depression and have 'abnormal' behavior patterns including anxiety and somatization (conversion of an emotional, mental, or psychosocial problem to a physical complaint). This has led to the idea that IBS has a psychological as well as a biological basis and a growing body of evidence supports the use of antidepressants for IBS, write the authors.

However, many doctors are reluctant to prescribe such agents to patients who are clearly not depressed.

Other "psychological" therapies exist that patients with IBS should be made aware of, they say. For example, 'talking therapies' such as cognitive behavior therapy are as effective as antidepressant treatment and its benefits may last longer.

Hypnotherapy has also been reported to be an effective intervention for IBS in small trials, although a recent review of hypnotherapy trials found insufficient evidence to recommend its widespread use and suggested that this treatment option should be restricted to specialist centers dealing with more severe cases of the syndrome.

Nevertheless, hypnotherapy has the potential to help those patients whose IBS is severe, say the authors.

The choice of treatment will depend on the individual patient and, inevitably, will be limited by local availability, they add. However, IBS is undeniably very common and many patients are probably denied help by lack of access to therapists with the appropriate psychological skills.

They believe that increasing provision of primary care services for patients with IBS will provide an avenue for effective and early psychological treatment for a condition in which real improvement can be achieved.

Source: Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. BMJ 2007 May 26;334:1105-1109 [Abstract]
 

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