Irritable bowel syndrome: symptomatic treatment versus integrative psychotherapy

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder thought to affect 10% to 20% of the population worldwide. Essentially the paper is in two parts. The first part of the paper investigates the world literature and a variety of up to date treatment approaches which, with the exception of cognitive-behavioural therapy (CBT) which also has beneficial effects on patients' overall mood and bloating, are designed to manage individual symptoms of IBS. The review examines the efficacy of pharmaceutical agents (antispasmodics, antidepressants, antidiarrhoeals and the new serotonergic modifying agonists/antagonists), dietary control (fibre, lactose free products, partially hydrolyzed guar gum, peppermint oil, prebiotics and probiotics), CBT (with or without the use of an audiotape) and the standard gut-directed hypnotherapy approach of the Manchester Model. In the second half, in sharp contrast to the symptomatic treatments, the authors give a detailed account of a 54-year-old female patient with refractory IBS in a setting of a phobic anxiety state. The treatment approach – a combination of psychotherapy and hypnosis – was designed to effect a complete recovery rather than to manage individual symptoms. This case study exemplifies the complex nature of IBS symptoms in relation to the patient's emotions. It was necessary for her to work through these emotional problems so that she did not need to express her intense hostility through her bowels. These problems were expressed both in the psychotherapy sessions as well as in the hypnotherapy. The patient made a full recovery and this was maintained at the follow-up a year later. Copyright © 2007 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.