Digital gut-directed hypnotherapy reduces abdominal pain in IBS patients

Digital gut-directed hypnotherapy (GDH) programme reduces abdominal pain in adults with irritable bowel syndrome (IBS) compared with digital muscle relaxation (MR), according to a study presented at DDW 2023.

Previous studies of behavioural therapy have demonstrated that GDH improved IBS symptoms for up to 12 months, reduced anxiety and depression, and improved quality of life, well-being, and functionality of patients, said lead author Dr Rani Berry from Stanford Medicine in Redwood City, California, US.

GDH is a highly effective brain-gut behavioural therapy recommended in international guidelines for the treatment of IBS. [Neurogastroenterol Motil 2023;doi:10.1111/nmo.14554] “However, access to in-person treatments severely limits our patients,” Berry noted.

This study enrolled 378 patients aged 18–70 years with IBS who reported an average worst daily pain severity score of ≥3 on an 11-point scale over a 4-week run-in period. Participants were randomized to receive treatment with either digital GDH, based on the North Carolina protocol, (n=188) or digital MR via a mobile app (n=190). Both programmes comprised seven treatment sessions (once every other week) for 12 months. [DDW 2023, abstract 606]

At 13–16 weeks post-treatment, 30.4 percent of the patients treated with GDH met the primary endpoint of achieving ≥30-percent reduction in average daily abdominal pain intensity from baseline compared with 27.1 percent of those treated with MR. However, the difference between groups were not statistically significant (p=0.5352).

There were more abdominal pain responders* in the GDH group than in the MR group over the last 4 weeks of treatment (weeks 9–12: 30.9 percent vs 21.5 percent; p=0.0232), as well as throughout the entire treatment period (weeks 1–12: 29.3 percent vs 18.8 percent; p=0.0254).

In terms of stool consistency, more GHD-treated patients achieved ≥30-percent improvement in the BSFS** scores (3, 4, or 5, indicating normal stools) than the MR-treated patients at weeks 13–16 post-treatment (44.9 percent vs 41.3 percent; p=0.51), though this finding did not reach statistical significance.

Overall, more than half of the patients treated with GDH reported adequate relief of IBS symptoms compared with those treated with MR (64.0 percent vs 59.9 percent).

No serious treatment-related adverse events were reported in either group during the study.

“It is well known that in-person GDH has been well validated for the treatment of IBS, … but the current study is the first randomized controlled trial to demonstrate the safety and efficacy of a self-administered all-digital GDH programme,” said Berry.

“We found that digital GDH is effective, and, therefore, we urge clinicians to consider the use of GDH as a part of integrated IBS care,” she highlighted.