Irritable Bowel Syndrome: When the colon is lying on the couch

20. January 2015
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Across the world about 5 to 20 percent of people suffer from irritable bowel syndrome. A definite explanation is not yet at hand, yet it is known that the state of mind affects the intestinal tract. Gastroenterologists have shown that psychotherapy and antidepressants reduce the symptoms.

Until now there has been no irrefutable explanation for irritable bowel syndrome. Whereas some patients tend to suffer from IBS type “D” (diarrhoea), others are affected by IBS type “C” (constipation). With many of these intestinal cramps are most prominent. Sufferers try to keep up with life using antispasmodics (mebeverine. butylscopolamine) or the diarrhoeal agent loperamide
It is today undisputed that mental processes have a great influence on irritable bowel syndrome. Many patients report, for instance, of being afflicted by diarrhoea on important dates. Various studies have shown that forms of psychotherapy have a positive effect on irritable bowel syndrome. Gastroenterologist Alexander C. Ford and colleagues (St. James’s University Hospital, Leeds, UK) wanted to create a detailed overview and thus conducted a systematic review and a meta-analysis on the topic “antidepressants, psychotherapy and irritable bowel syndrome”. They studied only randomised, controlled trials. In all of the studies patients were more than 16 years old. The diagnosis was based either on the judgement of the practitioner or the patients met the diagnostic criteria for Rome I, II or III.

Only “real” psychotherapy helped

As part of the psychotherapy studies, study participants received either psychotherapy or a standard treatment from their doctor. In addition patients on the waiting list served as control participants. As part of the medication trials patients were treated with either antidepressants (tricyclic antidepressants (TCA). selective serotonin reuptake inhibitors (SSRI)) or placebo.
The authors were in total able to evaluate 46 studies. It was found that only “real” psychotherapy or hypnotherapy achieved effective outcomes. Psychotherapies via internet, relaxation techniques and stress management programs resulted in no significant improvement. Dynamic psychotherapy resulted in 77 of 138 patients (56%) having a distinct improvement in their symptoms. In comparison, only 40 of 135 patients (29.6%) in the standard therapy group recorded an improvement. Cognitive behavioural therapy (CBT) worked effectively with 58% of the patients (204 of 349 patients), whereas only 36% (95 of 261 patients) in the control group demonstrated a weakening of symptoms. Hypnosis therapy was effective for 45% of the patients (64 of 141 patients), whereas only 23% of the control group (31 of 137 patients) reported alleviation of symptoms.

Treatment using antidepressants

With treatment using antidepressants, symptoms generally decreased: 56% of patients benefited (332 of 592 patients). In the placebo group things had improved for only 35% of patients (178 of 508 patients). Antidepressants were also effective in use with pain symptoms: aches eased for 52% of treated patients (92 of 182), whereas in the placebo group only 46 of 169 patients (27%) experienced relief. Overall, the authors evaluated seven randomised controlled trials on the topic “antidepressants and pain with irritable bowel syndrome”. Tricyclic antidepressants proved themselves to be as effective in the treatment of irritable bowel syndrome as were SSRI: The proportion of patients with symptom relief were 57% (TCA) and 54.5% (SSRI).

Impact of psychological trauma

The study by Alexander C. Ford and colleagues shows that psychological factors are involved in irritable bowel syndrome. Psychological trauma can be connected to dysfunctions of the intestinal tract. French researchers led by Anne-Marie Leroi found in a survey of 344 sexually abused patients that up to 40% of these patients suffer from irritable bowel syndrome. The prevalence rate here is twice as high as in the general population.

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mr. ron woering
mr. ron woering

I was treated for IBS for many years, till I was diagnosed with a food hypersensitivity. It appeared that I am missing an enzyme that breaks down histamine. Avoiding the foodstuff with high histamine concentrations my IBS cured within three months and never got back. Only when I “sin” against the diet the pain reoccurs within the hour.

As hypersensitivity is not within the “discipline” of many gastroenterologist this potential cause may be overlooked. Mine was diagnosed by an ENT-specialist / Allergist.

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