Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome

Abstract

Summary Background A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet is effective in treating irritable bowel syndrome (IBS). Aim To compare the effects of gut‐directed hypnotherapy to the low FODMAP diet on gastrointestinal symptoms and psychological indices, and assess additive effects. Methods Irritable bowel syndrome patients were randomised (computer‐generated list), to receive hypnotherapy, diet or a combination. Primary end‐point: change in overall gastrointestinal symptoms across the three groups from baseline to week 6. Secondary end‐points: changes in psychological indices, and the durability of effects over 6 months. Results Of 74 participants, 25 received hypnotherapy, 24 diet and 25 combination. There were no demographic differences at baseline across groups. Improvements in overall symptoms were observed from baseline to week 6 for hypnotherapy [mean difference (95% CI): −33 (−41 to −25)], diet [−30 (−42 to −19)] and combination [−36 (−45 to −27)] with no difference across groups (P = 0.67). This represented ≥20 mm improvement on visual analogue scale in 72%, 71% and 72%, respectively. This improvement relative to baseline symptoms was maintained 6 months post‐treatment in 74%, 82% and 54%. Individual gastrointestinal symptoms similarly improved. Hypnotherapy resulted in superior improvements on psychological indices with mean change from baseline to 6 months in State Trait Personality Inventory trait anxiety of −4(95% CI −6 to −2) P < 0.0001; −1(−3 to 0.3) P = ns; and 0.3(−2 to 2) P = ns, and in trait depression of −3(−5 to −0.7) P = 0.011; −0.8(−2 to 0.2) P = ns; and 0.6(−2 to 3) P = ns, respectively. Groups improved similarly for QOL (all p ≤ 0.001). Conclusions Durable effects of gut‐directed hypnotherapy are similar to those of the low FODMAP diet for relief of gastrointestinal symptoms. Hypnotherapy has superior efficacy to the diet on psychological indices. No additive effects were observed.

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS

“…These data on individual symptom response are consistent with previous findings of a non-randomised comparative trial that reported a significant difference in the numbers responding to low FODMAP dietary advice (76%) compared with standard National institute for Health and Care Excellence (NICE) guideline dietary advice (54%) 63. One recent trial also compared the low FODMAP diet with hypnotherapy in IBS 71. Both interventions improved symptoms, although there was no difference in symptom severity between groups at 6 weeks.…”

“…The RCT previously described comparing low FODMAP advice with hypnotherapy examined the long-term symptomatic outcomes of patients 71. Lower severity scores were evident for overall symptoms in 24 patients in the low FODMAP group at 6 months compared with baseline, with an impressive 82% categorised as responders.…”

Dietary and pharmacological treatment of abdominal pain in IBS

“…Overall, the IBS dietary algorithm has been simplified to first-line (healthy eating, provided by any healthcare professional) and second-line (low FODMAP, provided by dietitian) dietary advice 32. An alternative to a low FODMAP diet that has shown equal efficacy is gut-directed hypnotherapy 33. In general, the low FODMAP diet remains controversial, and it still presents short-term and long-term limitations, including a high level of restriction that may be required in individual patients, the need for monitoring by an expert dietitian, potential for developing nutritional deficiencies, potential for changes in gut microbiota, lack of predictors of response as well as relative efficacy compared with other dietary, psychological or pharmacological interventions for IBS 34…”

The Low FODMAP Diet: Many Question Marks for a Catchy Acronym

“…Table 1 reports the clinical trials that are available in the literature on the effect of a low-FODMAP diet in IBS patients [3,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. In general, most studies and one meta-analysis [6] have shown that IBS symptoms, particularly bloating and abdominal pain, may benefit from this treatment.…”