O62 Which patients are most likely to benefit from gut-directed hypnotherapy for refractory irritable bowel syndrome?

Abstract

<h3>Introduction</h3> Despite its considerable evidence-base, gut-directed hypnotherapy for Irritable Bowel Syndrome (IBS) is still not widely available, and remains a finite resource, emphasising the need to select the patients most likely to benefit. To evaluate for predictive factors for response to hypnotherapy, we compared baseline characteristics between responders and non-responders in a post-hoc analysis from the largest randomised control trial of gut-directed hypnotherapy to date.¹ <h3>Methods</h3> Recruited patients with refractory IBS participated in a randomised clinical trial receiving gut directed hypnotherapy using the Manchester protocol¹. The primary outcome measure was response to hypnotherapy defined by a &gt;50 point improvement in IBS symptom severity score (IBS-SSS) The secondary outcome measure was a &gt;30% improvement in abdominal pain scores. In a post-hoc analysis, baseline characteristics including; age, gender, IBS-sub type, baseline non-colonic scores, baseline Hospital anxiety and depression (HAD) scores, quality-of-life (QoL) and EQ-5D scores were compared between responders and non-responders using a modified intention to treat analysis with multiple imputation. <h3>Results</h3> Overall, 342/448 (76.3%) of patients met the primary endpoint of &gt;50 point improvement in IBS-SSS. Patients that achieved the primary endpoint had significantly higher mean baseline non-colonic symptom scores (239.0 vs. 209.7, 29.3 (95% CI: 9.4, 49.2), P=0.005). There were no differences in baseline HAD anxiety (P=0.62) or depression (P=0.71) scores between responders and non-responders. There were also no significant differences in age (p=0.58), gender (P=0.12), IBS-subtypes (P=0.75), baseline QoL (P=0.93) or EQ-5D scores (P=0.23) between responders and non-responders. Overall, 59.8% of patients met the secondary end-point of &gt;30% reduction in pain scores. Patients that achieved &gt;30% improvement in pain scores had a higher baseline IBS severity (mean IBS-SSS: 334.7 vs. 316.7, 17.9 (95% CI: 1.6, 34.3), P=0.03), and a lower baseline HAD depression score (mean HAD depression: 6.8 vs. 8.0, -1.2 (-2.1, -0.3), P=0.012). <h3>Conclusion</h3> These data from the largest randomised trial of individualised, therapist delivered hypnotherapy, suggest that patients with a higher burden of somatic extraintestinal symptoms are most likely to benefit. Moreover, those with higher baseline IBS severity and lower depression scores are more likely to achieve improvement in abdominal pain. Careful clinical assessment of gastrointestinal, somatic and psychological symptom severity profiles may therefore be important in selecting the patients most likely to benefit from hypnotherapy. <h3>Reference</h3> Hasan, <i>et al. Gastroenterology</i> 2021;<b>160</b>(7):2605–2607.