Alleviating irritable bowel syndrome symptoms : pharmacotherapy and psychological interventions versus standalone pharmacotherapy

Abstract

Background: Irritable bowel syndrome (IBS) is characterized as the most prevalent functional gastrointestinal (GI) disorder, often leading to a dysfunctional and debilitating lifestyle. The exact aetiology of IBS is still not well known, and this introduces great challenges in providing adequate treatment for symptom alleviation (Ford, Holtman, & Talley, 2016). As a connection between the brain and gut was found to amplify pain stimuli during the stretching of the gut (Mertz, 2003), the addition of psychological interventions to pharmacotherapeutics may contribute greatly in the management of IBS symptoms. The following PICO question was therefore formulated: In adults suffering from Irritable bowel syndrome, are psychological interventions combined with pharmacotherapy more effective than pharmacotherapy alone in alleviating symptoms of the condition? (P) Adults with IBS (I) Psychological Interventions combined with pharmacotherpy (C) Pharmacotherapy alone (O) Symptom alleviation. Methods: Studies eligible for this review recruited adults and compared pharmacotherapy and psychological interventions versus pharmacotherapy alone, with IBS symptom alleviation being considered as the outcome of interest. Studies which recruited individuals aged below 16 years or compared other forms of therapies, addressing different outcomes, were excluded. Only systematic reviews, meta-analysis, randomised controlled trials, case control studies, cohort studies and cross- sectional studies were considered for this review. Seven randomised controlled studies were retrieved and critically appraised by utilising the Critical Appraisal Skills Programme (CASP) tool. Results: Findings were consistent in favouring pharmacotherapy combined with psychological interventions over pharmacotherapy alone for optimal IBS symptom management, yet such consistency was not seen at follow-up periods. It can be concluded that combination therapy provides more beneficial effects. Implications and Recommendations: Further research is required to address methodological limitations, in view of creating local protocols. A multi-cultural aspect needs to be addressed to overcome such issue globally. Furthermore, stronger interdisciplinary links may enhance treatment effect amongst IBS sufferers