Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome.
Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome.
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DOI：
10.1053/j.gastro.2018.03.063
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发表时间：
2018-07
期刊：
影响因子：
29.4
通讯作者：
Sitrin MD
中科院分区：
文献类型：
--
作者：
Lackner JM;Jaccard J;Keefer L;Brenner DM;Firth RS;Gudleski GD;Hamilton FA;Katz LA;Krasner SS;Ma CX;Radziwon CD;Sitrin MD
目前迫切需要安全的肠易激综合征(IBS)治疗方法，以减轻难治性症状及其社会和经济负担。认知行为疗法(CBT)是一种尚未广泛应用于临床的有效治疗方法。我们进行了一项随机对照试验，以评估基于家庭的CBT与基于诊所的CBT和患者教育的临床反应。从2010年8月23日到2016年10月21日，我们在2个三级中心根据罗马III标准对436名IBS患者进行了前瞻性研究。受试者(41.4±14.8岁，女性占80%)被随机分配到接受标准CBT(S-CBT，n=14 6)的小组，包括每周10次，60分钟的训练，强调提供关于脑-肠道相互作用的信息；自我监测症状、其触发因素和后果；肌肉放松；焦虑控制；灵活解决问题；或4次家庭CBT(MC-CBT，n=145)，其中患者接受涵盖与S-CBT相同程序的家庭学习材料；或4次IBS教育(EDU，n=145)，提供有关IBS以及压力、饮食、运动等生活方式因素的支持和信息。根据临床总体印象改善量表的IBS版本，主要结果是IBS症状的全球改善。评级由患者和委员会认证的胃肠病医生进行，他们对治疗分配视而不见。在治疗结束后2周、3个月和6个月收集疗效数据。接受MC-CBT的患者在治疗2周后报告胃肠道症状有中度到实质性改善的比例(61.0%基于患者评级和55.7%基于胃肠病科医生的评级)高于接受EDU治疗的患者(43.5%基于患者评级和40.4%基于胃肠病专家评级)(P<；0.05)。治疗结束6个月后，胃肠病专家评定的胃肠道症状改善情况，MC-CBT组(58.4%)和EDU组(44.8%)之间也有显著差异(P=0.05)。多个对照的形式等价性检验表明，MC-CBT在改善IBS症状方面至少与S-CBT一样有效。基于治疗后对客户满意度问卷的即时反应，患者倾向于对CBT和EDU(P<；0.05)更满意。症状的改善与同时使用药物没有显著关系。在一项随机对照试验中，我们发现，与教育相比，主要基于家庭的CBT版本对IBS患者的胃肠道症状有显著和长期的改善。临床试验.gov编号：ClinicalTrials.gov/ct2/show/NCT00738920
There is an urgent need for safe treatments for irritable bowel syndrome (IBS) that relieve treatment-refractory symptoms and their societal and economic burden. Cognitive behavior therapy (CBT) is an effective treatment that has not been broadly adopted into routine clinical practice. We performed a randomized controlled trial to assess clinical responses to home-based CBT compared with clinic-based CBT and patient education. We performed a prospective study of 436 patients with IBS, based on Rome III criteria, at 2 tertiary centers from August 23, 2010 through October 21, 2016. Subjects (41.4±14.8 y old; 80% female) were randomly assigned groups that received: standard CBT (S-CBT, n=146, comprising 10 weekly, 60-min sessions that emphasized the provision of information about brain–gut interactions; self-monitoring of symptoms, their triggers, and consequences; muscle relaxation; worry control; flexible problem solving; and relapse prevention training), or 4 sessions of primarily home-based CBT requiring minimal therapist contact (MC-CBT, n=145), in which patients received home-study materials covering same procedures as S-CBT), or 4 sessions of IBS education (EDU, n=145) that provided support and information about IBS and the role of lifestyle factors such as stress, diet, exercise. The primary outcome was global improvement of IBS symptoms, based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Ratings were performed by patients and board-certified gastroenterologists blinded to treatment allocation. Efficacy data were collected 2 weeks, 3 months, and 6 months after treatment completion. A higher proportion of patients receiving MC-CBT reported moderate to substantial improvement in gastrointestinal symptoms 2 weeks after treatment (61.0% based on ratings by patients and 55.7% based on ratings by gastroenterologists) than those receiving EDU (43.5% based on ratings patients and 40.4% based on ratings by gastroenterologists) (P<.05). Gastrointestinal symptom improvement, rated by gastroenterologists, 6 months after the end of treatment also differed significantly between the MC-CBT (58.4%) and EDU groups (44.8%) (P= .05). Formal equivalence testing applied across multiple contrasts indicated that MC-CBT is at least as effective as S-CBT in improving IBS symptoms. Patients tended to be more satisfied with CBT vs EDU (P<.05) based on immediate post-treatment responses to the client satisfaction questionnaire. Symptom improvement was not significantly related to concomitant use of medications. In a randomized controlled trial, we found that a primarily home-based version of CBT produced significant and long-term gastrointestinal symptom improvement for patients with IBS compared to education. Clinicaltrials.gov no. clinicaltrials.gov/ct2/show/NCT00738920
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