PWE-063 Effectiveness of general hypnotherapy and gut-directed hypnotherapy in refractory irritable bowel syndrome: Abstract PWE-063 Table 1

Abstract

repetitive 10 Hz cortical transcranial magnetic stimulation (rTMS) and sham in the form of tilted coil. Results Data (mean6SEM) were analysed by two way ANOVA (see Abstract PWE-062 tables 1 and 2) showed a significant increase in sensory (ST) and pain (PT) thresholds immediately, at 30 and 60 min in the rectum following both 1 Hz rLSMS (ST (p¼0.015, 0.048 and 0.022, respectively), PT (p¼0.014, 0.004 and 0.012, respectively)) and 10 Hz rTMS (ST (p¼0.046, 0.041 and 0.017, respectively), PT (p¼0.005, 0.02 and 0.007, respectively)). In addition, only 10 Hz rTMS increased anal sphincter pain thresholds immediately, at 30 and 60 min after the intervention (PT (p¼0.032, 0.004 and 0.001, respectively)). Sham stimulation had no effect on any of the anorectal sensory parameters. Conclusion The application of repetitive magnetic stimulation to lumbosacral area and motor cortex is able to modulate human visceral sensitivity in IBS patients and holds promise as a future therapeutic intervention. Introduction Irritable bowel syndrome (IBS) is a very common condition, which constitutes up to 50% of Gastroenterology outpatient referrals. Many pharmacological and non-pharmacological treatments are available with variable results. Hypnotherapy is generally reserved for refractory IBS patients. Although there is ample evidence to show the effectiveness of Gut-directed Hypnotherapy (GDH), there are only few studies to support other forms of hypnotherapy especially general hypnotherapy. Aim of this study was to assess the effectiveness of different types of hypnotherapy on refractory IBS patients treated in our institution, a tertiary referral centre. Methods In our institution, an experienced hypnotherapist assesses refractory IBS patients. Based on their symptoms, patients receive either general hypnotherapy (GH), GDH or both. All patients score their IBS symptoms on IBS Symptom Score sheet [0e10 Likert scale, minimum score 0, maximum 60] first at the baseline (Pre-hypnotherapy score) and then at the end of the hypnotherapy (Immediate Post-hypnotherapy score). Patients also complete Hospital Anxiety and Depression (HAD) score sheet before and after hypnotherapy. We analysed the data of all patients treated with hypnotherapy between February 2009 and December 2011. Follow-up questionnaires were sent to all patients in the post at variable periods after the completion of hypnotherapy to score their current symptoms (Long-term Post-hypnotherapy score). Parametric methods were used for statistical analysis. Results During the study period, 34 patients (n¼34, females 29, mean age 41.5) received hypnotherapy (GH¼15, GDH¼8, both ¼11). Average number of hypnotherapy sessions was 4.7 (range 3e6, 1 h/week). Seventeen (50%) patients returned their follow-up questionnaires. Mean duration between the last session of hypnotherapy and completion of the follow-up questionnaire was 16 months (range 5e32). Abstract PWE-063 table 1 shows the main results. Conclusion Our study suggests that treatment of refractory IBS patients with general hypnothera...

Searching for a Definition of Refractory Irritable Bowel Syndrome: a Systematic Review and Meta-analysis

“…However, until now an established definition of refractory IBS is still lacking. Most of the papers refer to previous studies [26][27][28][29], which have established a definition on their own [30,31]. As there are no detailed guidelines available for the definition of refractory IBS, there is great uncertainty for clinical practice and inaccuracy for investigational trials.…”

“…Ten studies were performed in UK [24,27,30,31,39,42,46,49,52,53], 4 were from Sweden [38,41,47], and the remaining 7 experiments came from Canada, Turkey, Austria, France, USA, Germany, and Belgium, respectively [28, 40, 43-45, 48, 51]. Nineteen studies focused on the effectiveness of therapies (1 cross-over included) [24,27,28,30,31,[39][40][41][42][43][44][45][46][47][48][51][52][53], 1 mainly studied diagnostic approaches and 1 was about mechanism of hypnotherapy [38]. Two trials had a large sample size: Everitt (n=558) [52] and Lackner (n=436) [52].…”

“…Table III shows the results of the seven-item rating for summary of the definitions of refractory IBS in the included studies. Two (9.5%) studies used Rome I diagnostic criteria [49,53], 6 (28.6%) Rome II [38,39,41,46,48], 8 (38.1%) used Rome III [28, 40, 42-45, 51, 52], 3 (14.3%) used other diagnostic criteria [24,27,30], and 2 unmentioned [31,47]. Two (9.5%) studies provided sufficient information for the 7 items of diagnostic definitions [43,44].…”

“…Eight (38.1%) studies recruited participants with previous failure of dietary intervention, and 13 (61.9%) were unclear [27, 31, 38-42, 45-48, 51]. One (4.8%) study recruited participants who failed to change lifestyle [40], and 20 (95.2%) were unclear [24,27,28,30,31,38,39,[41][42][43][44][45][46][47][48][49][51][52][53]. Eleven (52.4%) studies recruited participants unresponsive to pharmacological intervention for ≥ 6 weeks [28,30,38,40,41,43,44,[51][52][53], and 10 (47.6%) were unclear [24,27,31,39,42,[45][46][47][48][49].…”

“…One (4.8%) study recruited participants who failed to change lifestyle [40], and 20 (95.2%) were unclear [24,27,28,30,31,38,39,[41][42][43][44][45][46][47][48][49][51][52][53]. Eleven (52.4%) studies recruited participants unresponsive to pharmacological intervention for ≥ 6 weeks [28,30,38,40,41,43,44,[51][52][53], and 10 (47.6%) were unclear [24,27,31,39,42,[45][46][47][48][49]. Two (9.5%) studies recruited participants unresponsive to psychology for ≥ 6 sessions [28,44], one (4.8%) did not apply this criteria [43], and 18 (85.7%) were unclear [24, 27, 30, 31, 38-42, 45-49, 51-53].…”