Digestion: Soothing a Sensitive Gut

By Kathleen Cahill Allison and Lawrence S. Friedman, M.D.

Newsweek

Sept. 27 issue - It's probably happened to you. You're driving to work and suddenly remember that a neglected assignment is due today. Your gut clenches, your intestines twist and before you know it you're feeling downright ill. One person in four ends up seeking medical attention for a gastrointestinal problem such as heartburn or irritable bowel syndrome (IBS). When doctors examine these patients, their blood tests and abdominal X-rays are usually normal. But the absence of ulcers or tumors doesn't mean that nothing is wrong. The brain and gut communicate through an impressive network of hormones, peptides and neurotransmitters. When emotional distress disrupts this dialogue, the effects can be seen on a brain scan. An area known as the midcingulate cortex goes into overdrive—and the gut suffers potentially devastating consequences.

Stress-related digestive problems often defy conventional treatments, such as antacids and anti-diarrhea medications. But mind-body techniques such as relaxation, hypnosis or cognitive behavioral therapy can provide a safe, effective alternative. Last year, for example, researchers at the University of North Carolina showed that cognitive behavioral therapy was effective in treating IBS. When the brain perceives pain, it tends to fret over the sensation and amplify it. In cognitive behavioral therapy, a trained therapist helps patients quell that amplification by reorienting negative ways of thinking. Instead of tensing up at the first sign of abdominal pain, a patient might learn to tell herself, "I can manage this pain and still live my life." In the North Carolina study, 70 percent of IBS patients reported less pain, bloating and diarrhea after 12 weeks of cognitive behavioral therapy, compared with just 37 percent who received only educational information about the condition. And when cognitive behavioral therapy was compared with the antidepressant desipramine, the two treatments were equally effective.

Studies are still lacking on other mind-body treatments for digestive problems, but several techniques are likely to help. Here are some remedies worth trying:

Relaxation therapy: Stress stimulates the autonomic nervous system, a part of the nervous system that controls such involuntary functions as heartbeat and intestinal contractions. Meditation and other relaxation techniques can calm the autonomic nervous system by tuning out stress-inducing thoughts, feelings and sensations. One common technique, known as progressive muscle relaxation, can be done alone or with a therapist. Simply lie or sit quietly, and then flex and relax each set of muscles, starting with your feet and progressing slowly upward to your neck and shoulders.

Hypnotherapy: This technique can help create a long-lasting state of relaxation and may help calm painful muscular motion in the intestine. A trained therapist can teach you the steps to enter a hypnotic state. You focus on your breathing and imagine what it feels like to be completely relaxed. Once you know the steps, you can use this technique to lower your tension and pain perception whenever symptoms strike.

Biofeedback: Using an electronic monitor at the office of a trained specialist, you learn to sense, and control, muscular activity in the bowel. No one knows exactly how biofeedback works, but the technique is widely accepted and many insurance plans will cover at least part of the cost of treatment.

Adapted from "The Sensitive Gut," a Special Health Report from Harvard Medical School. For more information go to health.harvard.edu/NEWSWEEK.

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Hypnotherapy Can Help Bowel Patients

By Kathleen Doheny
HealthDay Reporter
NBC Online
October 24, 2003 2:22 PM

(HealthDayNews) -- Hypnotherapy can help relieve symptoms of irritable bowel syndrome over the long term, says a new British study that followed patients for up to six years after they learned the technique.

Nearly three quarters of the more than 200 irritable bowel syndrome (IBS) patients responded well after being given hypnotherapy instruction, reporting fewer symptoms and needing less medication.

Sessions were one hour for up to 12 weeks, and then patients got a tape so they could perform it themselves.

The study appears in the November issue of Gut.

Those who responded had significant improvement in symptoms (such as abdominal pain, bloating and bowel problems) compared to the severity before they learned hypnotherapy, says Wendy Gonsalkorale, a researcher at the University Hospital of South Manchester in the United Kingdom. And for 81 percent of the initial responders, the relief lasted.

IBS is a very common gastrointestinal disorder, accounting for half the patient load of gastroenterologists, the specialists who treat such disorders. IBS symptoms also include constipation or diarrhea.

Symptoms don't always respond to conventional treatment, which can include special diets, agents to bulk up the stool, antispasmodic agents to relax the intestines, and even antidepressants, which may work by boosting the hormone serotonin in the gut and reducing abdominal pain.

Hypnotherapy does seem to work, although Gonsalkorale can't pinpoint how it does. "Certainly, we have shown in lab studies that hypnosis alters motility or muscle movement in the gut and the sensitivity of the gut lining, both of which are implicated in producing IBS symptoms," she says. "So there is a real physical effect here [from the hypnotherapy]."

It can also produce alteration in the immune response, she says. And pain relief can occur at the level of the brain, with the brain learning to ignore incoming pain messages.

"We also emphasize that the patient is developing control over the gut [rather than the other way around], and this is probably also a crucial factor in how the patient improves," she says.

Other studies have shown similar benefits of hypnotherapy.

In the current study, those who responded to the hypnotherapy also reported lower levels of anxiety and depression, Gonsalkorale found, although the improvement tailed off over time.

Patients who responded said they took fewer drugs and did not need to see their doctors as frequently after getting the hypnotherapy instruction. Before instruction, about 67 percent of patients were on medication, but during the follow-up only about 37 percent of responders were on medication, but nearly 56 percent of nonresponders were.

The continued improvement in symptoms wasn't associated with whether the responders continued to practice the hypnotherapy at home, as suggested. But 85 percent of the responders said they did continue the sessions on their own.

Experts in the United States say gastroenterologists are generally open to the suggestion of using hypnotherapy. Some suggest it to patients.

"I thought the study was very interesting," says Dr. Lucinda Harris, an associate professor of medicine at New York Weill Cornell Medical Center. The findings, she says, may demonstrate that "patients probably need a multifaceted approach."

"The only shortcoming really is there is no control group," says Dr. Steven Field, a clinical assistant professor of medicine at New York University School of Medicine and a private practice gastroenterologist in New York City.

"It's no surprise that patients who responded are still responding," he says. "Some are practicing the technique on a conscious or subconscious level."

The study shows, he adds, that hypnotherapy is "another mode for a condition that's frustrating for both the patient and the physician."

More information

To learn more about irritable bowel syndrome, go to the American College of Gastroenterology or the National Library of Medicine.

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.

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Hypnosis may offer benefits for IBS
Treatment improves symptoms of disorder, study finds

Reuters
MSNBC.com
October, 31, 2003

LONDON - Hypnotherapy can offer long-term benefits for patients suffering from irritable bowel syndrome, researchers said on Wednesday. In a study of more than 200 patients with the disorder, hypnotherapy helped to relieve the cramping, bloating and diarrhea or constipation caused by the syndrome for five years or more.

“This is the first long-term study of this nature,” Dr. Wendy Gonsalkorale, of the Withington Hospital in Manchester, England, told Reuters.

Patients who had undergone hypnosis reported an improvement in symptoms, a decrease in anxiety and depression, a better quality of life and said they took fewer drugs and saw their doctor less frequently after the treatment.

“It is a viable therapeutic option for the treatment of irritable bowel syndrome,” she said in a report in the journal Gut.

IBS is not a disease but a functional disorder in which the nerves and the muscles of the bowel are extra sensitive. It affects an estimated 10-20 percent of the population. Symptoms range from very mild to severe.

Gonsalkorale and her team questioned the patients about their symptoms and quality of life before and immediately after the 12 one-hour hypnotherapy sessions and for up to six years afterwards.

They found that 71 percent of patients responded well to the treatment and for most IBS sufferers the positive effects did not diminish after time.

The precise causes of IBS are not known but doctors believe a variety of things including food, exercise, hormones and stress may trigger the symptoms.

“There seem to be alterations in the muscle activity of the gut and its sensitivity,” said Gonsalkorale.

She said hypnotherapy affects how the brain talks to the body through impulses in the nerves, hormones and chemicals called neuropeptides.

“Using hypnosis you can very specifically influence physiological mechanisms in the body. It can be very specific and targeted,” Gonsalkorale added.

Hypnosis is probably best known for helping people to stop smoking or to recall unpleasant or traumatic events during psychotherapy. Gonsalkorale said it is also used to relieve pain during childbirth, for migraines and to treat skin conditions and asthma.

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