Abstract：
OBJECTIVE: Some brain-gut behavioral treatments (BGBTs) are beneficial for global symptoms in irritable bowel syndrome (IBS). United States management guidelines suggest their use in patients with persistent abdominal pain, but their specific effect on this symptom has not been assessed systematically.
METHODS: We searched the literature through December 16, 2023, for randomized controlled trials (RCTs) assessing efficacy of BGBTs for adults with IBS, compared with each other or a control intervention. Trials provided an assessment of abdominal pain resolution or improvement at treatment completion. We extracted data as intention-to-treat analyses, assuming dropouts to be treatment failures and reporting pooled relative risks (RRs) of abdominal pain not improving with 95% confidence intervals (CIs), ranking therapies according to the P score.
RESULTS: We identified 42 eligible randomized controlled trials comprising 5220 participants. After treatment completion, the BGBTs with the largest numbers of trials and patients recruited demonstrating efficacy for abdominal pain, specifically, included self-guided/minimal contact cognitive behavioral therapy (CBT) (RR, 0.71; 95% CI, 0.54-0.95; P score, 0.58), face-to-face multicomponent behavioral therapy (RR, 0.72; 95% CI, 0.54-0.97; P score, 0.56), and face-to-face gut-directed hypnotherapy (RR, 0.77; 95% CI, 0.61-0.96; P score, 0.49). Among trials recruiting only patients with refractory global IBS symptoms, group CBT was more efficacious than routine care for abdominal pain, but no other significant differences were detected. No trials were low risk of bias across all domains, and there was evidence of funnel plot asymmetry.
CONCLUSIONS: Several BGBTs, including self-guided/minimal contact CBT, face-to-face multicomponent behavioral therapy, and face-to-face gut-directed hypnotherapy may be efficacious for abdominal pain in IBS, although none was superior to another.
METHODS: We searched the literature through December 16, 2023, for randomized controlled trials (RCTs) assessing efficacy of BGBTs for adults with IBS, compared with each other or a control intervention. Trials provided an assessment of abdominal pain resolution or improvement at treatment completion. We extracted data as intention-to-treat analyses, assuming dropouts to be treatment failures and reporting pooled relative risks (RRs) of abdominal pain not improving with 95% confidence intervals (CIs), ranking therapies according to the P score.
RESULTS: We identified 42 eligible randomized controlled trials comprising 5220 participants. After treatment completion, the BGBTs with the largest numbers of trials and patients recruited demonstrating efficacy for abdominal pain, specifically, included self-guided/minimal contact cognitive behavioral therapy (CBT) (RR, 0.71; 95% CI, 0.54-0.95; P score, 0.58), face-to-face multicomponent behavioral therapy (RR, 0.72; 95% CI, 0.54-0.97; P score, 0.56), and face-to-face gut-directed hypnotherapy (RR, 0.77; 95% CI, 0.61-0.96; P score, 0.49). Among trials recruiting only patients with refractory global IBS symptoms, group CBT was more efficacious than routine care for abdominal pain, but no other significant differences were detected. No trials were low risk of bias across all domains, and there was evidence of funnel plot asymmetry.
CONCLUSIONS: Several BGBTs, including self-guided/minimal contact CBT, face-to-face multicomponent behavioral therapy, and face-to-face gut-directed hypnotherapy may be efficacious for abdominal pain in IBS, although none was superior to another.
摘要：
目的：一些脑肠行为治疗（BGBT）对肠易激综合征（IBS）的整体症状有益。美国管理指南建议将其用于持续性腹痛患者，但尚未系统地评估其对该症状的具体影响。
方法：我们在2023年12月16日的文献中搜索了评估BGBT对成人IBS疗效的随机对照试验（RCT），相互比较,或控制干预。试验提供了治疗完成时腹痛缓解或改善的评估。我们提取数据作为意向治疗分析，假设退出治疗失败，并报告腹痛的合并相对风险（RR）没有改善，95%置信区间（CI），根据P评分对治疗进行排序。
结果：我们确定了42个合格的RCT，有5220名参与者。治疗完成后，试验数量最多的BGBT，招募的病人，证明对腹痛的疗效，具体来说,包括自我指导/最小接触认知行为疗法（CBT）（RR=0.71；95％CI0.54-0.95，P评分0.58），面对面多成分行为治疗(RR=0.72；95%CI0.54-0.97，P评分0.56)，和面对面的肠道定向催眠疗法（RR=0.77;95％CI0.61-0.96，P评分0.49）。在仅招募具有难治性整体IBS症状的患者的试验中，CBT组比常规护理更有效，但没有检测到其他显著差异。没有试验在所有领域都存在低偏倚风险，并且有漏斗图不对称的证据。
结论：几个BGBT，包括自引导/最小接触CBT，面对面的多成分行为疗法，面对面的肠道催眠疗法可能对IBS的腹痛有效，虽然没有一个比另一个优越。
方法：我们在2023年12月16日的文献中搜索了评估BGBT对成人IBS疗效的随机对照试验（RCT），相互比较,或控制干预。试验提供了治疗完成时腹痛缓解或改善的评估。我们提取数据作为意向治疗分析，假设退出治疗失败，并报告腹痛的合并相对风险（RR）没有改善，95%置信区间（CI），根据P评分对治疗进行排序。
结果：我们确定了42个合格的RCT，有5220名参与者。治疗完成后，试验数量最多的BGBT，招募的病人，证明对腹痛的疗效，具体来说,包括自我指导/最小接触认知行为疗法（CBT）（RR=0.71；95％CI0.54-0.95，P评分0.58），面对面多成分行为治疗(RR=0.72；95%CI0.54-0.97，P评分0.56)，和面对面的肠道定向催眠疗法（RR=0.77;95％CI0.61-0.96，P评分0.49）。在仅招募具有难治性整体IBS症状的患者的试验中，CBT组比常规护理更有效，但没有检测到其他显著差异。没有试验在所有领域都存在低偏倚风险，并且有漏斗图不对称的证据。
结论：几个BGBT，包括自引导/最小接触CBT，面对面的多成分行为疗法，面对面的肠道催眠疗法可能对IBS的腹痛有效，虽然没有一个比另一个优越。
