The mind as a path to comfort for IBS

When a disease is poorly understood, when it's of a distinctly personal nature and when medication doesn't help, there's often little left to do but to suffer in silence.

That's the case for the 15% of Americans — about 25 million people — who have irritable bowel syndrome. Although television commercials and magazine advertisements promise easy relief for a chronically misbehaving gut, many people with the condition know better. The constipation, bloating, diarrhea and gas make their lives miserable, limiting some to short excursions when they leave home at all.

Although the pharmaceutical industry is eagerly pursuing new drug treatments for irritable bowel syndrome, these potentially more effective medications are several years away. Now researchers say the best hope may be the most basic of treatments: lifestyle changes.

Experts meeting last week in Los Angeles for Digestive Disease Week, the world's largest gathering of gastrointestinal health professionals, reported that behavior modification and dietary alterations can significantly ease symptoms of the still little-understood condition.

For example, even a brief, self-help course of cognitive behavior therapy — in which people identify their symptoms' triggers and learn techniques, such as relaxation and thought processes, that can alter the response — significantly helped most patients in one study presented at the meeting. Another study found that 12 sessions of hypnotherapy reduced symptoms in many patients for at least one year.

Dissatisfaction and safety concerns with Lotronex and Zelnorm, the two medications currently approved for IBS has led to a resurgence of interest in how patients can help themselves, said Jeffrey M. Lackner, an assistant professor of medicine at University at Buffalo, State University of New York.

"At this point, there are no drugs that seem to be satisfactory for the full range of symptoms," he said. "The real burden of IBS rests on the shoulders of patients on a day-to-day basis."

Psychotherapies may work just as well, without side effects, to alter the communication between the brain and the gut. In the government-sponsored behavior study presented last week, researchers randomly assigned 59 patients to receive a 10-week, clinic-based behavioral treatment; a four-session home-based program (using a self-study workbook); or nothing.

The behavior therapy goal is to learn new ways to think about the disorder and coping behaviors. For example, patients learn muscle relaxation exercises, which can reduce stress, and how to avoid worrying about having an "attack" out in public.

Overall, 74% of the patients in the 10-week program reported moderate to substantial improvement in symptoms, but so did 73% of the patients in the quicker and less costly, four-session program. A follow-up examination of the patients after three months showed the benefits persisted. Those who got no therapy did not improve.

The manner in which hypnotherapy works is harder to explain, said the lead author of that study, Dr. Magnus Simrén of Sahlgrenska University Hospital in Sweden.

In two studies, IBS patients were randomized to a group receiving hypnotherapy, one receiving education and visits from a nurse or no therapy at all. Just over half of the patients in the hypnotherapy group improved while the patients in the control groups did not.

"I was afraid patients would think this is hocus-pocus, but they were very open to it," Simrén said. "I think we need to address [IBS] with different kinds of therapies. We need new drugs. But we should not only focus on drugs."

Courtesy LA Times

Bonnie - while the focus of this story was on behavior, which is very important, it also mentioned dietary change, which is even more important. Eating incompatible and untolerated foods, and severe nutrient deprivation are often at the root of IBS symptoms. When one makes compatible and tolerant food choices, and corrects nutrient deficiencies, IBS symptoms are reduced. Concurrently, behavioral modification improves for the better.