Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials.

OBJECTIVE: We aimed to determine the efficacy of psychological treatments in irritable bowel syndrome. METHODS: A systematic review of the literature on psychological treatments of IBS was performed using Medline (1966-1994) and Psychlit (1974-1994) and secondary references. Fully published studies in English were selected if they compared any type of "psychological" treatment of irritable bowel syndrome with a control group. Studies without any comparable control group, studies in which the subject group was not confined to irritable bowel syndrome sufferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded. Each study was reviewed using a structured format to examine methodological issues. A quality algorithm was developed a priori based on eight key requirements. RESULTS: Eight studies (57%) reported that a psychological treatment was superior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior. By the quality algorithm, only one study (a hypnotherapy trial) exceeded the preset cutoff score of 6, but this study was poorly generalizable due to sample selection. CONCLUSION: The efficacy of psychological treatment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these design limitations.

Psychological distress and seasonal symptom changes in irritable bowel syndrome.

OBJECTIVE: It is not known whether irritable bowel syndrome (IBS) fluctuates with the seasons. We aimed to determine whether seasonal changes in symptoms occur in IBS and to examine the relationships between IBS, seasonality, and psychological factors. METHODS: A random sample of the community (n = 99) and hospital staff volunteers (n = 163) in Sydney, Australia, completed a previously validated questionnaire that measured bowel symptoms, psychosocial factors, and seasonality. RESULTS: IBS (n = 60; 23%) was significantly associated with somatization (by the Psychosomatic Symptom Checklist) and lifetime depression but not neuroticism (by the Eysenck Personality Questionnaire) or psychological morbidity (by the General Health Questionnaire). A seasonal variation in behavior score (measuring sleep, eating, including carbohydrate craving, weight gain, socializing, energy level, and mood by the Seasonal Pattern Assessment Questionnaire) was associated with somatization (p < 0.001) and IBS (p < 0.05) in a stepwise multiple regression model. Of those with IBS, 23% reported moderate or greater seasonal change in bowel symptoms. Subjects with IBS (vs subjects with some bowel symptoms) were significantly more likely to report seasonal changes in pain and/or disturbed defecation (odds ratio = 3.2; 95% CI = 1.25-8.23); the latter was significantly associated with somatization but not the other psychological variables. CONCLUSIONS: A subset of IBS may be seasonally determined, and this is explained in part by somatization.

Initial validation of a bowel symptom questionnaire and measurement of chronic gastrointestinal symptoms in Australians.

BACKGROUND: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but Australian data are lacking. A valid instrument is required to assess GI symptoms adequately and determine their prevalence in the community. AIMS: To test the feasibility, reliability and concurrent validity of a self-report Bowel Symptom Questionnaire (BSQ) as a measure of GI symptoms, and obtain preliminary data on the prevalence of symptoms in an Australian population-based sample. METHODS: Outpatients (n = 63), volunteers (n = 163) and a random sample (n = 99) of the Penrith population, Sydney, completed the BSQ. Feasibility was evaluated in 264 subjects. Reliability was measured by a test-retest procedure (n = 43), while concurrent validity was documented by comparing self-report data with an independent interview (n = 20). The response rate in the population mail survey was 68%. Prevalence data on bowel symptoms in the community sample (n = 99) were age and gender standardised to the Australian population. RESULTS: The majority of subjects found the BSQ easy to complete (97%) and understand (97%); 90% completed the questionnaire in half an hour or less. Reliability (median kappa 0.70, interquartile range 0.20) and concurrent validity (median kappa 0.79, interquartile range 0.26) of GI symptoms were both very acceptable. The internal consistency of all GI symptom scales was good (Cronbach's Alpha range 0.51-0.74). The prevalence of the irritable bowel syndrome (defined as abdominal pain and disturbed defaecation based on two or more of the Manning criteria) was 17.2% (95% CI: 10-25%). CONCLUSIONS: The BSQ was well accepted and easy to understand; it provided reliable and valid data on GI symptoms and should prove useful in large scale epidemiological studies in Australia.