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Cover of Mind-Body Interventions for Gastrointestinal Conditions

Mind-Body Interventions for Gastrointestinal Conditions

Evidence Reports/Technology Assessments, No. 40

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Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 01-E030ISBN-10: 1-58763-054-0

Structured Abstract

Objectives:

The objective of this evidence report was to conduct a search of the literature on the use of all mind-body therapies for the treatment of health conditions and, on the basis of that search, to choose either a condition or a mind-body modality for a comprehensive review. The health condition chosen, based on the results of an initial search, was gastrointestinal problems. The specific questions addressed in this project were: (1) What mind-body therapies have been used in the literature, for which body systems/conditions, and using what kind of research design? (2) What is the efficacy of mind-body therapies for the treatment of gastrointestinal problems?

Search strategy:

A research librarian performed an initial database search of MEDLINE®, HealthSTAR, EMBASE®, Allied and Complementary Medicine™, MANTIS™, PsycINFO®, Social Science Citation Index®, two files of Science Citation Index®, and CINAHL®. We used “mind/body relations (metaphysics)” and “mind body therapies” as the MeSH term and a set of synonyms for mind-body. A more focused search was conducted for gastrointestinal health problems and mind-body.

Selection criteria:

The literature search was confined to those mind-body therapies currently recognized as such by the National Center for Complementary and Alternative Medicine (NCCAM). In the initial search, all studies focusing on mind-body therapies were included. Those studies that focused on gastrointestinal (GI) problems were then identified. The mind-body therapies documented in the literature for treating GI problems included: behavioral therapy, biofeedback, cognitive therapy, guided imagery, hypnosis, placebo, relaxation therapy, and multimodal therapy.

Data collection and analysis:

All titles, abstracts, or articles were reviewed by two independent reviewers and entered into a database. The titles/or abstracts/or articles were analyzed and synthesized into a descriptive report. Particular attention was paid to the mind-body modality used, the target body systems/conditions, the outcomes measured, and the type of study design used. An in-depth analysis was conducted on those studies that focused on GI conditions. We identified 53 GI studies that included a concurrent comparison group. Because of the clinical heterogeneity of these trials, however, we did not conduct a meta-analysis. Instead, a qualitative synthesis was conducted.

Main results:

In the search of mind-body studies, the most common body systems/conditions for which mind-body therapy literature was found are: neuropsychiatric; head/ear, nose, and throat (head/ENT); gastrointestinal; circulatory; and musculoskeletal. Regarding therapies, the most common ones for which published studies were found were: biofeedback, hypnosis, relaxation, behavioral, and cognitive.For GI conditions, the most commonly studied mind-body therapy was biofeedback (n = 22), and the most commonly studied conditions were irritable bowel syndrome (n = 15), followed by fecal incontinence/encopresis (n = 11). Studies with a comparison group were reviewed for biofeedback (n = 17), hypnosis (n = 8), relaxation therapy (n = 8), behavioral therapy (n = 8), multimodal therapy (n = 4), cognitive therapy (n = 4), guided imagery (n = 2), and placebo (n = 1).

Eleven of the biofeedback studies had a no biofeedback comparison group, and two reported a significant benefit from biofeedback. These studies were of adults with fecal incontinence and nausea/vomiting following chemotherapy. In the remaining nine biofeedback trials, seven of which were on children, biofeedback was not reported to have any benefit. There were seven studies of hypnosis that had a no hypnosis comparison group, six of which reported a significant benefit (for irritable bowel syndrome, two studies; nausea/vomiting, two studies; duodenal ulcer, one study; and ulcerative colitis, one study). Six of the eight relaxation-therapy controlled trials reported a significant benefit for irritable bowel syndrome (two studies), nausea/vomiting (two studies), ulcer (one study), and GI distress (one study). For the eight studies in behavioral therapy, six studies with a no behavioral therapy comparison group reported a significant benefit for encopresis (one study), nausea/vomiting (two studies), irritable bowel syndrome (two studies), and abdominal pain (one study). In cognitive therapy, four studies, all with a no cognitive therapy comparison group, reported a significant benefit. These were for irritable bowel (three studies) and ulcer (one study). In guided imagery therapy, one out of two studies with a no imagery comparison group reported a significant benefit. In placebo therapy there was only a single study. Four studies using a multimodal intervention, which does not enable a conclusion about individual therapies, were also reviewed.

Conclusions:

There are limited data to support the efficacy of relaxation therapy, behavioral therapy, cognitive therapy and guided imagery as therapy for certain gastrointestinal conditions. There is no evidence to support the efficacy of biofeedback for children with gastrointestinal conditions, while for adults the evidence is mixed. The studies of hypnosis are limited by methodologic problems and no conclusions can be drawn.

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Southern California Evidence-based Practice Center/RAND Director: Paul Shekelle, MD, PhD. Co-Director and Senior Statistician: Sally C Morton, PhD. Task Order Director: Ian D Coulter, PhD. Task Order Co-Director: Mary Hardy, MD. Expert Reviewers: Ian D Coulter, PhD; Joya T Favreau, MD; Pamela Elfenbaum, MPH. Senior Programmer/Analyst: Elizabeth A Roth, MA. Task Order Coordinator: Barbara Genovese, MA. Reference Librarian: Roberta Shanman, MLS. Editor: Elizabeth Maggio, BA. Research Associate: Swamy Venuturupalli, MD. Staff Assistants: Leigh Rohr; Louis R Ramirez, BA.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0001. Prepared by: Southern California Evidence-based Practice Center/RAND.

Suggested citation:

Coulter ID, Hardy ML, Favreau JT, et al. Mind-Body Interventions for Gastrointestinal Conditions. Evidence Report/Technology Assessment No. 40 (Prepared by Southern California Evidence-based Practice Center/RAND under Contract No. 290-97-0001). AHRQ Publication No. 01-E030. Rockville (MD): Agency for Healthcare Research and Quality; July 2001.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. Endorsement by the Agency for Healthcare Research and Quality (AHRQ) or the Department of Health and Human Services (DHHS) of such derivative products may not be stated or implied.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.

1

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Bookshelf ID: NBK33758
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