Aspects of the non-pharmacological treatment of irritable bowel syndrome

Abstract

Irritable bowel syndrome (IBS) is one of the most commonly diagnosed gastrointestinal conditions. It represents a significant healthcare burden and remains a clinical challenge. Over the years IBS has been described from a variety of different perspectives; from a strict illness of the gastrointestinal tract (medical model) to a more complex multi-symptomatic disorder of the brain-gut axis (biopsychosocial/psychosomatic model). In this article we present aspects of the pathophysiology and the non-pharmacological treatment of IBS based on current knowledge. Effects of conditioned stress and/or traumatic influences on the emotional system (top-down) as well as effects on the intestine through stressors, infection, inflammation, food and dysbiosis (bottom-up) can affect brain-gut communication and result in dysregulation of the autonomic nervous system (ANS), playing an important role in the pathophysiology of IBS. Conditioned stress together with dysregulation of the autonomic nervous system and the emotional system may involve reactions in which the distress inside the body is not recognized due to low body awareness. This may explain why patients have difficulty identifying their symptoms despite dysfunction in muscle tension, movement patterns, and posture and biochemical functions in addition to gastrointestinal symptoms. IBS shares many features with other idiopathic conditions, such as fibromyalgia, chronic fatigue syndrome and somatoform disorders. The key to effective treatment is a thorough examination, including a gastroenterological examination to exclude other diseases along with an assessment of body awareness by a body-mind therapist. The literature suggests that early interdisciplinary diagnostic co-operation between gastroenterologists and body-mind therapists is necessary. Re-establishing balance in the ANS is an important component of IBS treatment. This article discusses the current knowledge of body-mind treatment, addressing the topic from a practical point of view.

Keywords: Irritable bowel syndrome; Assessment; Treatment; Hypnotherapy; Pathophysiology; Body awareness therapy; Psychosomatics; Stress; Body-mind

Core tip: Due to the complex nature of irritable bowel syndrome (IBS), no long-lasting generally accepted therapies are available. Different lines of research have been developed to address this issue. One line focuses on identifying intestinal mechanisms that may be affected by pharmacologic intervention. The understanding of IBS, especially the interactions between the central and enteric nervous systems, has grown considerably in recent years. Because recent research has focused more on the body-mind aspect of the disease, body-mind remedies such as hypnotherapy, psychotherapy and body awareness therapy have been applied. In highlighting this topic we discuss non-pharmacological methods and practical guidelines for the treatment of IBS.