Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Behavioral therapy for IBS

Nature Reviews Gastroenterology & Hepatology volume 6, pages 148–149 (2009)Cite this article

Over the past 10 years considerable progress has been made in understanding the pathophysiology of IBS. IBS is now recognized as a multifactorial condition that involves disturbances of motility, visceral sensation and the central processing of noxious stimuli from the gut.1 In addition, evidence shows that inflammation and genetic influences may also be important.1 Despite these findings, psychological factors have always been the focus of considerable attention in the clinical setting, to the extent that IBS is often dismissed as a purely psychological condition. IBS is an excellent example of the medical profession's tendency to classify an illness as either organic or psychological, with the consequence that those conditions classified as psychological are sometimes regarded in a somewhat unsympathetic light. In 1977, Engel proposed the 'biopsychosocial' model of disease,2 which seeks to explain the expression of an illness in terms of an integrated response to biological and psychosocial factors; IBS is a perfect example of an illness that fits this model.3

On the basis of our understanding of the pathophysiology of IBS, its medical management should first include an attempt to modify gastrointestinal motility, for example with antispasmodic, antidiarrheal or laxative drugs. The pharmacological modulation of visceral sensation is still in its infancy, but some evidence shows that antidepressants might have some utility in this respect.4 Clinically, little doubt remains that a low dose of a tricyclic antidepressant can be a very effective treatment for a significant proportion of patients with IBS, and some data support this view,5 however, how this benefit is mediated remains uncertain. Even if the mechanism of action of these drugs has a peripheral nervous system component, additional activity of antidepressants on the central nervous system seems likely. Virtually no data show whether a reduction in inflammation is of any use in the treatment of IBS, although one rationale for the use of probiotics in this condition is that these agents may possess anti-inflammatory activity. Unfortunately, despite the use of conventional pharmacological approaches, the symptoms of many patients with IBS remain refractory to treatment and these individuals are often told that nothing more can be done for them.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Drossman DA et al. (2002) AGA technical review on irritable bowel syndrome. Gastroenterology 123: 2108–2131

    Article  Google Scholar 

  2. Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196: 129–136

    Article  CAS  Google Scholar 

  3. Drossman DA et al. (1996) Gastrointestinal illness and the biopsychosocial model. J Clin Gastroenterol 22: 252–254

    Article  CAS  Google Scholar 

  4. Hobson AR and Aziz Q (2007) Modulation of visceral nociceptive pathways. Curr Opin Pharmacol 7: 593–597

    Article  CAS  Google Scholar 

  5. Jackson JL et al. (2000) Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med 108: 65–72

    Article  CAS  Google Scholar 

  6. Kearney DJ and Brown-Chang J (2008) Complementary and alternative medicine for IBS in adults: mind–body interventions. Nat Clin Pract Gastroenterol Hepatol 5: 624–636

    Article  Google Scholar 

  7. Naliboff BD et al. (2008) Mind/body psychological treatments for irritable bowel syndrome. Evid Based Complement Alternat Med 5: 41–50

    Article  Google Scholar 

  8. Gonsalkorale WM et al. (2003) Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 52: 1623–1629

    Article  CAS  Google Scholar 

  9. Whorwell PJ et al. (2008) Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms. J Psychosom Res 64: 621–623

    Article  Google Scholar 

  10. Miller V and Whorwell PJ (2008) Treatment of inflammatory bowel disease: a role for hypnotherapy? Int J Clin Exp Hypn 56: 306–317

    Article  Google Scholar 

  11. Gralnek IM et al. (2000) The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 119: 654–660

    Article  CAS  Google Scholar 

  12. Miller V et al. (2004) Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2: 1064–1068

    Article  Google Scholar 

  13. UK National Institute for Health and Clinical Excellence (online February 2008) Irritable Bowel Syndrome [http://www.nice.org.uk/Guidance/CG61#summary] (accessed 12 January 2009)

Download references

Author information

Author notes

  1. Wythenshawe Hospital, 1st Floor, ERC, Southmoor Road, Manchester M23 9LT, UK peter.whorwell@manchester.ac.uk

Authors and Affiliations

  1. PJ Whorwell is a Professor of Medicine and Gastroenterology at University of Manchester, Manchester, UK.,

    Peter J Whorwell

Authors
  1. Peter J Whorwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Whorwell, P. Behavioral therapy for IBS. Nat Rev Gastroenterol Hepatol 6, 148–149 (2009). https://doi.org/10.1038/ncpgasthep1361

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep1361

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing