O61 Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis

Abstract

<h3>Introduction</h3> National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. <h3>Methods</h3> We searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane central register of controlled trials through January 2020 to identify randomised controlled trials (RCTs) assessing the efficacy of psychological therapies for adults with IBS. Trials included in the analysis reported a dichotomous assessment of symptom status after completion of therapy (≥4 weeks), and data were pooled using a random effects model. We examined 6 and 12-month outcomes, where reported. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% confidence interval (CI) to summarise efficacy of each comparison tested. Treatments were ranked by therapy according to P-score. <h3>Results</h3> We identified 41 eligible RCTs, containing 4072 participants. At the first point of follow-up, after completion of therapy, contingency management was ranked first, but 95% CIs were wide (RR of remaining symptomatic = 0.39; 95% CI 0.19 to 0.84, P-score 0.89), and this was based on only one small RCT (figure 1). The psychological interventions with the largest numbers of trials, and patients recruited, included self-administered or minimal contact CBT (RR = 0.61; 95% CI 0.45 to 0.83, P-score 0.66), face-to-face CBT (RR = 0.62; 95% CI 0.48 to 0.80, P score 0.65), and gut-directed hypnotherapy (RR = 0.67; 95% CI 0.49 to 0.91, P-score 0.57). CBT-based interventions and gut-directed hypnotherapy were the most efficacious long-term. Risk of bias of individual trials was high, meaning that the efficacy of all psychological therapies studied is likely to have been overestimated. <h3>Conclusions</h3> Several psychological therapies are efficacious for IBS, although none were superior to another. CBT-based interventions and gut-directed hypnotherapy had the largest evidence base. Future RCTs should examine the effect of psychological therapy earlier in the disease course, before patients are refractory to medical management.