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Effect of Antidepressants and Psychological Therapies, Including Hypnotherapy, in Irritable Bowel Syndrome: Systematic Review and Meta-Analysis

Ford, Alexander C MBChB, MD1,2; Quigley, Eamonn M M MD, FRCP, FACP, FACG, FRCPI3; Lacy, Brian E MD, PhD4; Lembo, Anthony J5; Saito, Yuri A6; Schiller, Lawrence R MD, MSHS, RFF, FACG, AGAF7; Soffer, Edy E8; Spiegel, Brennan M R MD, MSHS, RFF, FACG, AGAF9; Moayyedi, Paul MBChB, PhD, MPH, FACG10

American Journal of Gastroenterology: September 2014 - Volume 109 - Issue 9 - p 1350–1365
doi: 10.1038/ajg.2014.148

OBJECTIVES: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder. Evidence relating to the treatment of this condition with antidepressants and psychological therapies continues to accumulate.

METHODS: We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Trials recruiting adults with IBS, which compared antidepressants with placebo, or psychological therapies with control therapy or “usual management,” were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI).

RESULTS: The search strategy identified 3,788 citations. Forty-eight RCTs were eligible for inclusion: thirty-one compared psychological therapies with control therapy or “usual management,” sixteen compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Ten of the trials of psychological therapies, and four of the RCTs of antidepressants, had been published since our previous meta-analysis. The RR of IBS symptom not improving with antidepressants vs. placebo was 0.67 (95% CI=0.58–0.77), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms not improving with psychological therapies was 0.68 (95% CI=0.61–0.76). Cognitive behavioral therapy, hypnotherapy, multicomponent psychological therapy, and dynamic psychotherapy were all beneficial.

CONCLUSIONS: Antidepressants and some psychological therapies are effective treatments for IBS. Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained remarkably stable.

1Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK

2Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK

3Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA

4Dartmouth-Hitchcock Medical Center, Gastroenterology, Lebanon, New Hampshire, USA

5The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

6Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

7Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA

8Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, Califoria, USA

9Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

10Division of Gastroenterology, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada

Correspondence: Alexander C Ford, MBChB, MD, Leeds Gastroenterology Institute, St James's University Hospital, Beckett Street, Room 125, 4th Floor, Bexley Wing, Leeds LS9 7TF UK. E-mail:

Received 25 February 2014; accepted 29 April 2014

Guarantor of the article: Alexander C. Ford, MBChB, MD.

Specific author contributions: A.C.F., E.M.M.Q., B.E.L., A.J.L., Y.A.S., L.R.S., E.E.S., B.M.R.S., and P.M. conceived the study. A.C.F. and P.M. collected all data, analyzed and interpreted the data. A.C.F. drafted the manuscript. All authors commented on drafts of the paper. All authors have approved the final draft of the manuscript.

Financial support: This work was supported by American College of Gastroenterology.

Potential competing interests: None.

© The American College of Gastroenterology 2014. All Rights Reserved.
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