BACKGROUND AND AIMS: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question. PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy. CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.

Gut. 2003 Nov;52(11):1623-9. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Department of Medicine, University Hospital of South Manchester, Manchester, UK. wgonsalkorale@compuserve.com

Full Title: Mind-body complementary alternative medicine use and quality of life in adolescents with inflammatory bowel disease.

BACKGROUND:: Mind-body complementary and alternative medicine (CAM) modalities (e.g., relaxation or meditation) for symptom management have not been well studied in adolescents with inflammatory bowel disease (IBD). The purposes of this study were to: 1) determine the prevalence of 5 types of mind-body CAM use, and consideration of use for symptom management; 2) assess characteristics associated with regular mind-body CAM use; and 3) examine whether regular and/or considered mind-body CAM use are associated with health-related quality of life (HRQOL). METHODS:: Sixty-seven adolescents with IBD ages 12-19 recruited from a children's hospital completed a questionnaire on CAM use and the Pediatric Quality of Life Inventory. Logistic regression models were estimated for regular and considered CAM use. RESULTS:: Participants mean (SD) age was 15.5 (2.1) years; 37 (55%) were female; 53 (79%) were white; and 20 (30%) had moderate disease severity. Adolescents used prayer (62%), relaxation (40%), and imagery (21%) once/day to once/week for symptom management. In multivariate analyses, females were more likely to use relaxation (odds ratio [OR] = 4.38, 95% confidence interval [CI] = 1.25-15.29, c statistic = 0.73). Younger adolescents were more likely to regularly use (OR = 0.63, 95% CI = 0.42-0.95, c statistic = 0.72) or consider using (OR = 0.77, 95% CI = 0.59-1.00, c statistic = 0.64) meditation. Adolescents with more severe disease (OR = 4.17, 95% CI = 1.07-16.29, c statistic = 0.83) were more willing to consider using relaxation in the future. Adolescents with worse HRQOL were more willing to consider using prayer and meditation for future symptom management (P < 0.05). CONCLUSIONS:: Many adolescents with IBD either currently use or would consider using mind-body CAM for symptom management. Inflamm Bowel Dis 2009.

Inflamm Bowel Dis. 2009 Aug 24. Cotton S, Humenay Roberts Y, Tsevat J, Britto MT, Succop P, McGrady ME, Yi MS. Department of Family Medicine, University of Cincinnati College of Medicine.

The Irritable bowel syndrome (IBS) is a highly prevalent functional disorder with a remarkable clinical and economic impact. Several pathogenetic factors of IBS are discussed and summarised within a bio-psycho-social model. Data from published hypnotherapeutic interventions with approximately 800 patients show long-lasting symptom relief. The underlying mechanisms of action are not well understood. Nine mechanism studies show influences of hypnosis on colorectal sensitivity, colorectal motility and mental strain (anxiety, depression, maladaptive cognitions). Results are often contradictory and effects of hypnosis on several of the proposed pathogenetic factors are not examined at all. This paper reviews previous studies on hypnotherapy in IBS patients with a focus on symptom relief and mechanisms of action.

Z Gastroenterol. 2009 Nov;47(11):1153-9. Epub 2009 Nov 6. Hefner J, Rilk A, Herbert BM, Zipfel S, Enck P, Martens U. Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universität Tübingen. jochen.hefner@t-online.de

Full Title: Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy

A medical artist asked 109 patients if they had an image of their IBS pre- and posthypnotherapy, making precise watercolor paintings of any images described. Results were related to treatment outcome, symptoms, anxiety, depression, and absorption (hypnotizability); 49% of patients had an image, and a wide variety were recorded and painted. Imagery was significantly associated with gender (p < .05), anxiety (p < .05), noncolonic symptomatology (p < .05), and absorption (p = .001); 57.8% of responders compared with 35.5% of nonresponders to hypnotherapy had an image of their disease (p < .05) before treatment, and color images were associated with better outcomes (p = .05) than monochrome ones. All images changed in responders, often becoming more nonspecific in nature. Inquiring about IBS imagery helps to identify potential responders and nonresponders to hypnotherapy and may also provide insights into how patients think about their illness.

Int J Clin Exp Hypn. 2009 Apr;57(2):162-73. Carruthers HR, Miller V, Morris J, Evans R, Tarrier N, Whorwell PJ. University of Manchester, United Kingdom.

Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

Int J Clin Exp Hypn. 2009 Jul;57(3):279-92. Miller V, Whorwell PJ. University of Manchester, Manchester, United Kingdom.

BACKGROUND: Irritable bowel syndrome (IBS), a functional bowel disorder with symptoms of abdominal pain and disturbed defecation experienced by 10% of U.S. adults, results in significant disability, impaired quality of life, and health-care burden. Conventional medical care focusing on pharmacological approaches, diet, and lifestyle management has been partially effective in controlling symptoms. Behavioral treatments, such as cognitive-behavioral therapy and hypnosis, are promising. This paper describes an on-going feasibility study to assess the efficacy of mindfulness training, a behavioral treatment involving directing and sustaining attention to present-moment experience, for the treatment of IBS. METHODS/DESIGN: The study design involves randomization of adult women with IBS according to Rome II criteria, to either an eight-week mindfulness training group (based on a Mindfulness-based Stress Reduction [MBSR] format) or a previously validated IBS social-support group as an attention-control condition. The primary hypothesis is that, compared to Support Group participants, those in the Mindfulness Program will demonstrate significant improvement in IBS symptoms as measured by the IBS Symptom Severity Scale [1]. DISCUSSION: 214 individuals have been screened for eligibility, of whom 148 were eligible for the study. Of those, 87 were enrolled, with 21 withdrawing after having given consent. 66 have completed or are in the process of completing the interventions. It is feasible to undertake a rigorous randomized clinical trial of mindfulness training for people with IBS, using a standardized MBSR protocol adapted for those experiencing IBS, compared to a control social-support group previously utilized in IBS studies. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00680693.

BMC Complement Altern Med. 2009 Jul 28. Gaylord SA, Whitehead WE, Coble RS, Faurot KR, Palsson OS, Garland EL, Frey W, Mann JD. Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. susan_gaylord@med.unc.edu

(1) Patients frequently complain of occasional bowel movement disorders, associated with abdominal pain or discomfort, but they are rarely due to an underlying organ involvement. Even when patients have recurrent symptoms, serious disorders are no more frequent in these patients than in the general population, unless other manifestations, anaemia, or an inflammatory syndrome is also present; (2) There is currently no way of radically modifying the natural course of recurrent irritable bowel syndrome; (3) The effects of antispasmodics on abdominal pain have been tested in about 20 randomised controlled trials. Pinaverium and peppermint essential oil have the best-documented efficacy and only moderate adverse effects. Antispasmodics with marked atropinic effects do not have a favourable risk-benefit balance; (4) Tricylic antidepressants seem to have only modest analgesic effects in this setting. In contrast, their adverse effects are frequent and they have somewhat negative risk-benefit balances. Nor has the efficacy of selective serotonin reuptake inhibitor antidepressants (SSRIs) been demonstrated; (5) Alosetron and tegaserod carry a risk of potentially life-threatening adverse effects and therefore have negative risk-benefit balances; (6) Seeds of plants such as psyllium and ispaghul, as well as raw apples and pears, have a limited impact on constipation and pain. Osmotic laxatives are effective on constipation. Symptomatic treatments for constipation can sometimes aggravate abdominal discomfort; (7) Loperamide has been poorly assessed in patients with recurrent irritable bowel syndrome with diarrhoea. It modestly slows bowel movement but does not relieve pain or abdominal discomfort; (8) Dietary measures have not been tested in comparative trials. Some patients are convinced that certain foods provoke a recurrence of irritable bowel syndrome, but restrictive diets carry a risk of nutritional deficiencies; (9) Various techniques intended to control emotional and psychological disturbances have been proposed, including relaxation, biofeedback, hypnosis, and psychotherapy. The results of clinical trials are not convincing; (10) Oral products containing live bacteria, designed to change the equilibrium of intestinal flora, have been tested in 13 placebo-controlled trials, with inconsistent results. A few cases of septicaemia have been reported; (11) The six available trials of acupuncture (versus sham acupuncture) showed no more than a placebo effect; (12) In practice, patients who have recurrent irritable bowel syndrome but with no other signs of a condition warranting specific treatment should be reassured as to the harmless nature of their disorder if a careful physical examination and basic laboratory tests are negative. The only available treatments have purely symptomatic effects and only limited efficacy. It is best to avoid using all treatments and additional diagnostic investigations that carry a risk of disproportionate adverse effects.

Prescrire Int. 2009 Apr;18(100):75-9.

Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of 8 white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = -3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found.

Int J Clin Exp Hypn. 2007 Oct;55(4):457-66. Keefer L, Keshavarzian A. Rush University Medical Center, Chicago, Illinois, USA. laurie.keefer@northwestern.edu

by Robert DeMaria DC, DABCO, FASBE, NHD

Are you ready for another fat article? By now most people in America have been so inundated with news about FAT that there we are actually living in a FAT phobia epidemic. Confusion is everywhere. FAT or OIL is not the ENEMY the kind of oil the consumers are choosing is the problem!! You need to make wise selections. Well meaning FREE LANCE writers are looking for information to attempt to educate the public about staying thin while you eat. The food manufactures are scurrying to find an alternative for the oils they fry and cook with, keeping the taste appealing and the government off their backs while attempting keep the profit margins up for their investors. Read any of the business news papers and you will see huge players in the food industry make announcements on changing their source of cooking oils. Do you know why they are switching? Better educated consumers are demanding healthier ingredients. Education and the access to information have changed the world in which we eat and live.

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There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there exists research demonstrating the efficacy of cognitive-behavioral therapy (CBT) in the treatment of IBS. However, there is little written about the integration of CBT and hypnotherapy in the treatment of IBS and a lack of clinical information about IBS-induced agoraphobia. This paper describes the etiology and treatment of IBS-induced agoraphobia. Cognitive, behavioral, and hypnotherapeutic techniques are integrated to provide an effective cognitive-behavioral hypnotherapy (CBH) treatment for IBS-induced agoraphobia. This CBH approach for treating IBS-induced agoraphobia is described and clinical data are reported.

Int J Clin Exp Hypn. 2007 Apr;55(2):131-46. Golden WL. williamgolden@optonline.net

To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). QUALITY OF EVIDENCE: MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. MAIN MESSAGE: Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. CONCLUSION: Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.

Can Fam Physician. 2009 Feb;55(2):143-8. Comment in: Can Fam Physician. 2009 Feb;55(2):126-7, 128-9. Shen YH, Nahas R. Department of Family and Community Medicine at University of Ottawa in Ontario.

Idiopathic inflammatory bowel diseases (IBDs) significantly affect the quality of life of sufferers. Improved quality of life and patient symptom management may be achieved through integrating psychological/behavioral interventions with pharmacologic treatments. Here is our experience with hypnotherapy as an adjuvant management for an 18-year-old female with Crohn's Disease (CD) in remission (patient I) and a 24-year-old female with CD in active phase (patient II). The patients participated in 12 weekly one-hour sessions of hypnotherapy. Gut-directed, ego-strengthening, and post-hypnotic suggestions and immune-directed imaginations were used. After the hypnotherapy course, symptoms, psychological state, and quality of life improved in patient I, but not patient II (according to questionnaires). After a 6 month follow-up, symptoms and quality of life were the same as at the end of hypnotherapy sessions in both patients. The patients reported the greatest benefit of hypnotherapy was in helping them to cope better with their disease and also in improving their psychological state. Hypnotherapy may improve quality of life of IBD patients in remission and help them to cope better with their disease. Well-designed controlled clinical trials are needed in this field.

Am J Clin Hypn. 2009 Jan;51(3):255-62. Emami MH, Gholamrezaei A, Daneshgar H. Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran.

Prognostic factors that predict the efficiency of autogenous training and psychopharmacotherapy were detected in 90 women with irritable bowel syndrome and constipation. A multifactor personality questionnaire, Spielberg's state-trait anxiety test, Beck's depression inventory scale, and visual analog scale were used for the purpose of psychodiagnosis. The efficiency of autogenous training was found to be higher in patients with irritable bowel syndrome and mildly or moderately compromised psychological adaptation associated with a moderately elevated level of anxiety. Psychopharmacotherapy proved to be especially efficacious in patients with hypochondriac, depressive, and manifest anxiety disorders. It was found that the pronouncedness of rigidity, tension, fixation-proneness, and the degree of depression could be used as predictors of positive effects of psychopharmacotherapy on stool patterns while hypochondriac trends served as predictors of the alleviation of pain syndrome in patients with irritable bowel syndrome and constipation.

Vopr Kurortol Fizioter Lech Fiz Kult. 2008 Sep-Oct;(5):6-8. A?vazian TA, Za?tsev VP, Pakhomova IV, Gusakova EV.

Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of "gut-focused hypnotherapy" and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.

Int J Clin Exp Hypn. 2008 Jul;56(3):306-17. Miller V, Whorwell PJ. University of Manchester, United Kingdom.

Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options.

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Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.

World J Gastroenterol. 2008 Nov 7;14(41):6276-84. Chiarioni G, Palsson OS, Whitehead WE. Divisione di Riabilitazione Gastroenterologica dell'Universita di Verona, Azienda Ospedaliera di Verona, Ospedale di Valeggio sul Mincio, 37067 Valeggio sul Mincio (VR), Italy. chiarioni@tin.it.

It was established that use of autogenous training makes possible to increase efficiency of the therapy, leading to considerable more evident improvement of somatic and psychotic state, decrease of pain syndrome. Predictors of efficiency of autogenous training were marked out. Indications for use the method in medical rehabilitation of patients with irritable colon syndrome with constipation dominance were elaborated.

Vopr Kurortol Fizioter Lech Fiz Kult. 2008 Jan-Feb;(1):24-7. Pakhomova IV, A?vazian TA, Za?tsev VP, Gusakova EV, Molina LP.

by Debra Mittler, CHt

There is an ever growing epidemic of eating disorders amongst both women and men. Some start as young as six years of age. People who develop eating disorders usually do it to cope with life circumstances. It is an unconscious reaction to develop a sense of control, escape feelings, avoid responsibility or stop the process of life. They "think" these behaviors make them feel better. They usually are not aware of, and are disconnected from the physical and emotional harm they are doing on their mind, body and spirit. These people tend to have low self-esteem and can view themselves with a lot of negativity. Some feel that nothing is ever good enough, (mostly themselves). Generally their thoughts, feelings and behaviors stem from the limiting beliefs they have about themselves and the world.

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ABSTRACT: BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription mediation were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. CONCLUSIONS: CAM is used by one-third of FBG patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner M, Drossman DA, Whitehead WE. BMC Complement Altern Med. 2008 Jul 24;8(1):46.

INTRODUCTION: The treatment of the fibromyalgia syndrome (FMS) is not standardized and often ineffective, and the course of disease progression is unpredictable. OBJECTIVES: To highlight the efficacy of the pharmacologic and nonpharmacologic treatments administered to FMS patients. METHODS: Medline search for articles published between 1983 and 2007, using the keywords fibromyalgia, pharmacologic and nonpharmacologic treatment, and multidisciplinary modalities. RESULTS: Randomized controlled trials (RCTs) indicate that FMS has been treated by a wide range of drugs including antidepressants, opioids, nonsteroidal anti-inflammatory drugs, sedatives, muscle relaxants, and antiepileptic agents. Although the syndrome is now more widely recognized and understood, its treatment remains challenging and some physicians believe that no effective treatment exists. Only a few drugs have been shown to have clear-cut benefits in RCTs. FMS sufferers benefit from exercise and a number of the tested programs have involved more than 1 type of exercise. Two other major approaches are psychophysiologically based therapy, such as electromyography biofeedback, and interventions based on cognitive-behavioral therapy. Twelve controlled clinical studies have provided evidence supporting the efficacy of treatments administered to people with FMS by multidisciplinary teams using multicomponent strategies. CONCLUSIONS: It is difficult to draw definite conclusions concerning the most appropriate approach to managing FMS because of the methodological limitations of the available studies and the fact that the heterogeneity and nonstandardized nature of their therapeutic programs make them difficult to compare. An individually tailored multidisciplinary pharmacologic, rehabilitative, and cognitive-behavioral approach currently seems to be the most effective.

Semin Arthritis Rheum. 2008 Jun;37(6) Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F. Clinical Research Scientist, Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. sarzi@tiscali.it

Irritable bowel syndrome (IBS) is one of the most common conditions seen in primary care settings. Despite this, there is no consensus as to the pathogenesis of this disorder or a consistently effective therapeutic regimen for many patients. This has encouraged the use of various alternative therapies from behavioral or complementary medicine. This review will address the evidence for alternative therapies, including the following: cognitive behavior therapy, hypnosis, elimination diets based on food antibody testing, nutrition supplements (such as fiber, probiotics, and prebiotics), and, finally, peppermint, l-glutamine, zinc, and cromolyn sodium. The review also explores the evidence for and the therapeutic ramifications of the hypothesis that increased intestinal permeability underlies the symptoms of IBS in many patients, and how a therapeutic plan that addresses nutrition, elimination diets, and nutrition supplements may be useful in restoring the integrity of the gut immune barrier.

Wald A, Rakel D. Section of GI and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. axw@medicine.wisc.edu Nutr Clin Pract. 2008 Jun-Jul;23(3):284-92.

There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.

J Psychosom Res. 2008 Jun;64(6):621-3. Epub 2008 Apr 28. Whorwell PJ. University of Manchester, Manchester, United Kingdom. peter.whorwell@manchseter.ac.uk

There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.

J Psychosom Res. 2008 Jun;64(6):621-3. Epub 2008 Apr 28. Whorwell PJ. University of Manchester, Manchester, United Kingdom.

OBJECTIVES: Hypnotherapy is effective in several diseases with a psychosomatic component. Our aim was to study the effects of one session of hypnosis on the systemic and rectal mucosal inflammatory responses in patients with active ulcerative colitis (UC). METHODS: In total, 17 patients with active UC underwent a 50-min session of gut-focused hypnotherapy. Before and after each procedure, the systemic inflammatory response was assessed by serum interleukin (IL)-6 and IL-13 concentrations, tumor necrosis factor-alpha (TNF-alpha) and IL-6 production by lipopolysaccharide (LPS)-stimulated whole blood, leukocyte count, natural killer (NK) cell number, platelet activation, and platelet-leukocyte aggregate formation. Rectal inflammation was assessed by mucosal release of substance P (SP), histamine, IL-13 and TNF-alpha, reactive oxygen metabolite production, and mucosal blood flow. Eight patients with active UC underwent a control procedure. RESULTS: Hypnosis decreased pulse by a median 7 beats per minute (bpm) (P= 0.0008); it also reduced the median serum IL-6 concentration by 53% (P= 0.001), but had no effect on the other systemic variables assessed. Hypnosis reduced rectal mucosal release of SP by a median 81% (P= 0.001), histamine by 35% (P= 0.002) and IL-13 by 53% (P= 0.003), and also, blood flow by 18% (P= 0.0004). The control protocol had no effect on any of the variables assessed. CONCLUSIONS: Hypnosis reduced several components of the systemic and mucosal inflammatory response in active ulcerative colitis toward levels found previously in the inactive disease. Some of these effects may contribute to the anecdotally reported benefits of hypnotherapy and provide a rationale for controlled trials of hypnotherapy in UC.

Am J Gastroenterol. 2008 May 28. Mawdsley JE, Jenkins DG, Macey MG, Langmead L, Rampton DS. Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London, Queen Mary School of Medicine and Dentistry, London, United Kingdom.

A driving force in an eating disorder like anorexia nervosa has been a distorted body image. The psychobiological dynamics of eating disorders have demonstrated significant hypnotic phenomena such as forms of dissociation, hallucination, time distortion and catalepsy, and therefore, pose hypnosis as a good fit for particular parts of treatment. Presented here are four hypnotic approaches designed to inspire the establishment of a reality based body image in the eating disordered individual. Conditional prerequisites for application of these interventions are described and case examples illustrate each approach. A discussion on some of the rationale for formulating these strategies is offered.

Am J Clin Hypn. 2008 Apr;50(4):301-10. Walsh BJ. affinity@bigplanet.com

by Melissa Roth, Ph.D.

Jackie characterized her Irritable Bowel Syndrome (IBS) symptoms as a panic attack of the bowels. Sudden, explosive episodes of diarrhea had her confined to her house. She had tuned over the grocery shopping to her husband and had not been on an outing with her family in three years.

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Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of 8 white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = -3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found.

Int J Clin Exp Hypn. 2007 Oct;55(4):457-66. Keefer L, Keshavarzian A. Rush University Medical Center, Chicago, Illinois, USA. laurie.keefer@northwestern.edu

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms. OBJECTIVES: To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome. SEARCH STRATEGY: Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched. SELECTION CRITERIA: Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention. DATA COLLECTION AND ANALYSIS: All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient's overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events. MAIN RESULTS: Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic effect of hypnotherapy was found to be superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy. Harmful side-effects were not reported in any of the trials. However, the results of these studies should be interpreted with caution due to poor methodological quality and small size. AUTHORS' CONCLUSIONS: The quality of the included trials was inadequate to allow any conclusion about the efficacy of hypnotherapy for irritable bowel syndrome. More research with high quality trials is needed.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005110. Webb AN, Kukuruzovic RH, Catto-Smith AG, Sawyer SM. Royal Children's Hospital Melbourne, Gastroenterology, Flemington Road, Parkville Victoria 3052, Melbourne, Australia. annette.webb@rch.org.au

Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. METHODS: Fifty-three pediatric patients, age 8-18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the SMT group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy. RESULTS: Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001). CONCLUSIONS: Gut-directed HT is highly effective in the treatment of children with longstanding FAP or IBS.

Gastroenterology. 2007 Nov;133(5):1430-6. Epub 2007 Sep 2. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands. a.vlieger@antonius.net

A case of secondary diurnal enuresis (SDE) after a car accident was treated with hypnosis by means of the Hypnotic Trauma Narrative, an instrument created by the authors for use with children who have been exposed to traumatic events and develop either classic symptoms of posttraumatic stress disorder or manifest other psychosomatic symptoms. An ABAB time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of diurnal incontinence. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Hypnosis with the Hypnotic Trauma Narrative was deemed efficacious as a method for the treatment of secondary diurnal enuresis.

The patient was symptom-free at follow-up 6 months later.

Int J Clin Exp Hypn. 2008 Apr;56(2):229-40. Iglesias A, Iglesias A. Private Practice, Palm Beach Gardens, Florida, USA.

To elucidate the role of music therapy in gastrointestinal endoscopic procedures following the conflicting outcomes reported in two recent studies. The findings of our recent meta-analysis that examined this matter were discussed in the context of later studies. Our meta-analysis illustrated the beneficial effects of music therapy on patient anxiety levels when used as a single measure of relaxation and analgesia. Beneficial effects were also shown on analgesia and sedation requirements and procedure duration times when used as an adjunct to pharmacotherapy. These findings are in agreement with those of both studies excluded from analysis and those that followed it. Music therapy is an effective tool for stress relief and analgesia in patients undergoing gastrointestinal endoscopic procedures.

World J Gastroenterol. 2007 Sep 7;13(33):4533. Rudin D. King's Daughters' Hospital and Health Services, Madison, IN 47250, USA. rudind@gmail.com

Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of 8 white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = -3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found. Int J Clin Exp Hypn. 2007 Oct;55(4):457-66. Keefer L, Keshavarzian A. Rush University Medical Center, Chicago, Illinois, USA.

Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of 8 white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = -3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found.

Int J Clin Exp Hypn. 2007 Oct;55(4):457-66

Keefer L, Keshavarzian A. Rush University Medical Center, Chicago, Illinois, USA.

by Bunny Vreeland, Ph.D.

For years, doctors have been saying that Stress is the cause of IBS. I'm Dr. Bunny Vreeland, and while I believe and agree that Stress can and does exacerbate IBS, my personal research with my own clients shows that 100% of my clients were involved in some sort of Body Trauma prior to the onset of IBS. After researching the histories of many of my clients' over the past seven years, it is my belief and contention that IBS is caused by Body Trauma rather than stress, alone.

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Relieving abdominal pain is the principal treatment objective for patients with irritable bowel syndrome. No single drug stands out in the treatment strategy for this illness. Antispasmodics, magnesium aluminum silicates, and alverine citrate drugs all remain initial options for treatment, although their prescription is impeded by the fact that an increasing number are no longer approved for reimbursement. Increased dietary fibers often have a harmful effect on symptoms. Some patients are probably intolerant to some foods but there is no satisfactory proof on which to base a restrictive diet. Improved knowledge of the pathophysiology of irritable bowel syndrome has made it possible to diversify treatments that act first on one of the key pathophysiologic elements, visceral hypersensitivity. Antidepressants (especially tricyclics) can be used at low doses. Among the serotonergic drugs, serotonin 5-HT4 receptors agonists (tegaserod) may be available soon, but the development of 5-HT3 antagonists (alosetron, cilansetron) has been stopped for safety reasons (ischemic colitis and severe constipation). Non-drug options such as hypnosis, psychotherapy, relaxation, or yoga, may also be proposed to some patients. Probiotics are a possible treatment in the future.

Departement d'hepatogastroenterologie et de nutrition, Centre hospitalier, ADEN EA 3234 / IFRMP 23, Rouen (76). Presse Med. 2007 May 7

Comment from Tim Brunson DCH: Although this article does not specifically mention hypnosis or other mind/body modalities, I thought that it was significant since many hypnotherapists provide services with IBS. Note that relaxation and slower breathing helps the brain stem stimulate serotonin. Since activation of the parasympathetic nervous system and serotonin production are significant to GI functioning, hypnosis, guided imagery, and relaxation are significant. The article focuses on pharmacological interventions and unfortunately does not discuss the significant of hypnosis, et. al., as an adjunctive treatment.

Alternative therapies hold potential promise for the treatment of urinary incontinence in the elderly. Assessment and comparisons of the efficacies of such therapies have been hindered by a lack of standardized definitions of urinary incontinence in the study populations, lack of standardization of treatment protocols, inadequate sample sizes, and lack of blinding and appropriate controls. Biofeedback has been the most extensively studied therapy and may provide appropriate adjunctive or primary therapy for select individuals. Other potential therapies, such as acupuncture, hypnosis, and herbal therapies, have not been sufficiently examined to make definitive recommendations.

Division of Geriatrics and Gerontology, Leonard M. Miller School of Medicine, University of Miami and the Miami VA Health Care System. Correspondence address: Room 1D200, Miami VA Medical Center, 1201 NW 16 St, Miami, FL 33125 Email: evan.cherniack@med.va.gov.

Researchers from University Hospital of South Manchester in the UK review the latest research on the efficacy of hypnotherapy for irritable bowel syndrome, and conclude that the beneficial effects of hypnotherapy are long lasting, with most patients maintaining their improved status and decreasing their need for office visits and medication in the long term.

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About 20% of people in the UK have functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia.

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This study quantified health-related quality of life in a group of irritable bowel syndrome patients and measures changes following a treatment programme of nurse-led gut-directed hypnotherapy. BACKGROUND: It is well recognized that health-related quality of life can be severely impaired in patients suffering form the irritable bowel syndrome. Current conventional treatment for irritable bowel syndrome is often unsatisfactory. In contrast it has been shown that gut-directed hypnotherapy is an effective treatment of irritable bowel syndrome with up to three-quarters of patients reporting symptomatic improvement. DESIGN/METHOD: Seventy-five patients (55 females/20 males, median age 37.1 years, age range 18-64) comprised the study group. Physical symptoms of irritable bowel syndrome were recorded using seven-day diary cards. On presentation the predominant symptoms were abdominal pain (61%), altered bowel habit (32.5%), and abdominal distension/bloating (6.5%) in the patient group. An irritable bowel syndrome quality of life questionnaire was used to define health-related quality of life. Psychological well-being was measured using the Hospital Anxiety and Depression Scale. Data analysis was carried out using MINITAB, Release 12 for Windows. RESULTS: Physical symptoms statistically improved after hypnotherapy. There were also significant statistical improvements (P < 0.001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physical function, energy and social role). These improvements were most marked in female patients who reported abdominal pain as their predominant physical symptom. Anxiety and depression improved following treatment. CONCLUSION: Gut-directed hypnotherapy has a very positive impact on health-related quality of life with improvements in psychological well-being and physical symptoms. It appears most effective in patients with abdominal pain and distension. Relevance to clinical practice. This study demonstrates that by integrating complementary therapies into conventional care that gastrointestinal nurses have a potential role in the management of irritable bowel syndrome.

School of Health in Social Science, University of Edinburgh, Old Medical School, Edinburgh, UK. graeme.smith@ed.ac.uk

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS.