Pain Catastrophizing and Clinical Outcomes Among Patients Receiving a Novel Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: An Experimental Therapeutics Approach

Yoga, Meditation, Mindfulness, or Hypnotherapy for GI Disorders: Similar Mechanisms of Action?

Mind-body approaches aim to improve gut symptoms and quality of life by targeting the interaction between the central nervous system and the enteric nervous system. These include treatments such as hypnotherapy, mindfulness, meditation, and yoga. Although evidence is building on efficacy of mind-body approaches, we generally lack a thorough understanding of how they work. Despite being presented as separate treatment modalities, mind-body approaches often use overlapping treatment aspects with the same mechanism of action. There is evidence that yoga, meditation, and hypnotherapy may partly draw their benefit from creating an absorbed state of attention combined with suggestions for change. This has implications for clinical application of these treatments in patients with GI disease. We propose studies on mechanisms of mind-body approaches to develop more efficacious and more precise treatments for GI diseases.

Gastrointestinal Cognition: Pain Catastrophizing in Irritable Bowel Syndrome, a Cross-Sectional Study in Mexico

INTRODUCTION AND AIMS

Pain catastrophizing is more common in individuals with irritable bowel syndrome (IBS) than in healthy individuals. Despite this, its prevalence and impact in Latin American populations remain under-researched.

OBJECTIVE

To assess pain catastrophizing differences between IBS patients and healthy subjects.

MATERIALS AND METHODS

Cross-sectional study in which subjects with IBS and healthy individuals (HC) were recruited from our tertiary care center. IBS diagnosis was established based on the Rome IV criteria. All participants answered the pain catastrophizing scale (PCS), the hospital anxiety and depression scale (HAD), and the irritable bowel syndrome severity scoring system (IBS-SSS). Group comparisons employed the Student's t-test or Mann-Whitney U test, with Pearson's or Spearman's for correlations and logistic regression to assess IBS predictors.

RESULTS

A total of 920 participants (66.4% women) with a median age of 23 years (range: 18-60) met the inclusion criteria. IBS individuals had a higher prevalence of clinically significant pain catastrophizing compared to healthy subjects (22.5% vs. 11%, p < 0.0001). When classified by symptom intensity, 52.2% of IBS individuals with severe symptoms exhibited significant catastrophizing, compared to 25.3% with moderate symptoms and 14.7% with mild symptoms (p < 0.0001). Anxiety (OR 2.5, 95% CI 1.9-3.4, p < 0.0001), depression (OR 1.7, 95% CI 1.3-2.3, p < 0.0001), and catastrophizing (OR 2.3, 95% CI 1.6-3.3, p < 0.0001) were significantly associated with IBS.

CONCLUSIONS

In Mexican individuals with IBS, pain catastrophizing is associated with more severe gastrointestinal symptoms and psychological distress. Comprehensive management of IBS in this population should involve addressing cognitive patterns in conjunction with conventional treatments.

A primer for the gastroenterology provider on psychosocial assessment of patients with disorders of gut-brain interaction

BACKGROUND

GI-specific psychological factors are important contributors to patients' symptom experience and quality of life across all disorders of gut-brain interaction (DGBI). Clinicians' ability to recognize the role of these psychological factors is essential for formulating a biopsychosocial case conceptualization and informing treatment decisions.

PURPOSE

This article will familiarize gastroenterology providers with conceptualizing the role of GI-specific psychological factors in DGBI and provides stepwise, practical guidance for how to assess these during clinical encounters in a time-efficient manner.

Prevalence of Eating Disorders Among Adults With Irritable Bowel Syndrome

Goal:

To investigate the prevalence of eating disorder (ED) symptoms among Mexican adults with irritable bowel syndrome (IBS).

Background:

The relationship between IBS and EDs is complex, yet understudied, particularly in Latin America.

Methods:

In this cross-sectional study, 369 Mexican adults (18 to 69  y), comprising 133 IBS patients and 236 healthy controls (HCs), were evaluated using the Rome IV criteria, The Spanish version of the Eating Disorder Examination Questionnaire (S-EDE-Q), the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis included the Student t test or the Wilcoxon Rank-sum test for group comparisons, the Kruskal-Wallis test for multiple comparisons, and logistic regression, with a significance threshold set at a P-value of <0.05.

Results:

IBS individuals were at an increased risk for clinically significant S-EDE-Q when compared with HCs (12.8% vs. 3.8%, odds ratio OR 3.6, 95% CI: 1.5-8.5; P=0.001), especially among younger individuals. IBS individuals displayed a higher risk for dietary restraint and heightened concerns about eating, body shape, and weight. In addition, binge-eating episodes occurred more frequently within the IBS group. Notably, there were no significant differences in body mass index between individuals with clinically significant S-EDE-Q and those with normal scores. IBS individuals with severe symptoms had higher S-EDE-Q scores; furthermore, those with IBS and clinically significant S-EDE-Q exhibited higher levels of anxiety and depression.

Conclusions:

Our study reveals a significantly higher risk for ED in IBS individuals compared with HCs. This highlights the crucial importance of conducting ED screenings before dietary interventions, particularly among younger individuals and those displaying elevated levels of anxiety and depression.

Psychotherapy for Irritable Bowel Syndrome: A Systematic Review

Psychotherapy has many forms, such as cognitive behavioral therapy (CBT), mindfulness therapy (MFT), and hypnotherapy, to name a few. Cognitive behavioral therapy is the gold standard in therapy-based treatment and is used for cognitive restructuring to reduce safety-seeking and avoidant behaviors. While the main application of psychotherapy is psychological disorders, recent studies have found that it is beneficial for somatic and physiological symptoms such as chronic pain or even irritable bowel syndrome (IBS). Irritable bowel syndrome is a common but debilitating gastrointestinal condition that has a prevalence of 12% in the United States and costs the average patient $9,776 annually in 2023. Irritatable bowel syndrome is a condition of exclusion but consists of abdominal discomfort or pain and must be associated with altered bowel habits as stated in the Rome IV criteria. At least half of these patients also exhibit extracolonic symptoms, most commonly psychological disorders like anxiety and stress. The true etiology of IBS is not understood, but ideas such as the brain-gut axis, stress response system, and gut microbiota have been evaluated. Treatment of IBS is extensive and heavily relies on the patient-physician interaction, but pharmacologic therapies have been employed and are sometimes unsuccessful. Irritable bowel syndrome impacts an individual as a whole, making them hesitate whether or not they eat a particular food or even go out to do an activity because of the unpredictable bowel pattern. Finding a better solution is essential to improving the patient's quality of life (QoL), especially by addressing how they perceive the illness, how they adjust to it, and even how they determine what foods to consume. This paper aims to evaluate whether or not psychotherapy can be employed to improve all aspects of IBS, as well as if it can reduce the cost of IBS treatment.