title: Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease.
abstract: BACKGROUND
  Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD.
  
  
  METHODS
  A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed.
  
  
  RESULTS
  Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P < 0.05) in overall gastrointestinal symptoms following treatment usually compared to supportive therapy only. Response rates amongst those who received gut-directed hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials.
  
  
  CONCLUSIONS
  Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required.
authors: Department of Gastroenterology, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Vic., Australia.
authors: S L
authors: SL
authors: Peters
authors: J G
authors: JG
authors: Muir
authors: P R
authors: PR
authors: Gibson
mesh_terms: D001921:Brain / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D006990:Hypnosis / Q000379:methods*; D015212:Inflammatory Bowel Diseases / Q000523:psychology / Q000628:therapy*; D043183:Irritable Bowel Syndrome / Q000523:psychology / Q000628:therapy*