Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial, 2019, Everitt et al

Authors also include McCrone, Chalder and Moss-Morris.

Open access, https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30243-2/fulltext

 

Does anyone from IBS community critically analyse these in the way we do for SMILE etc?
It may be enlightening

 

Buy our product.

 

Again subjective outcomes in an open label trial, without any adequate control.

No wonder this larger group of researchers are so defensive of such as PACE and of this methodology for evaluating CBT. So much research and so many reputations rely on it.

What happened to a general acceptance forty years ago that if you have methodological problems in particular research approaches, often an issue in clinical research, the best way forward is to seek confirming evidence from different and varied experimental designs and sources, not double down on the one problematic approach?

 

This is one of the issues I have with FND. They treat it with physio and CBT to persuade patients that there is no actual disease.

There seems no reason to think that the psychological treatments add anything. Personally I would not class therapeutic massage as a complementary treatment. They treat frozen shoulder by manipulation under anaesthetic and I found that massage helped my body remember where it should be by moving it in ways I could not manage myself.

 

Don't even need to read further than this. Dropout rates of this order make the results impossible to interpret.

Ah, there it is. Obviously. But it would be too complex to properly account for difference in eating habits. How many participants who improved had a horrible diet to begin with? There are far too many factors involved to ascribe any benefits to therapy itself when it includes modifying eating habits, which are obviously a primary aspect of reducing, though not treating, IBS. A control arm with nutritional advice (and possibly some financial support to sustain since eating healthy is more expensive) would have been necessary, without one nothing can be concluded.

Typical garbage from the usual CBT brigade.

 

"The bastards don't want to get better"

Or something like this.

Why don't people like our treatments? Clearly they are wrong because we are obviously right.

 

CBT, TM, and yoga never helped my IBS. I will say again...probiotics help my IBS. We have seen a number of studies that show disordered gut bacteria appears to play a significant role in IBS. The following are just 2 such studies:


"Gut dysbiosis and irritable bowel syndrome: The potential role of probiotics."

RESULTS:
IBS is a common disease for which no resolutive therapy is presently available. In recent years, strong evidence of a possible relationship between modifications of the gut microbiota composition and development of IBS has been collected. Moreover, the evidence showed that attempts to treat acute infectious and post-antibiotic gastroenteritis with some probiotics were significantly effective in a great number of patients, leading many experts to suggest the use of probiotics to address all of the clinical problems associated with IBS.

CONCLUSION:
The available data are promising, but presently, a precise definition of which probiotic or which mixture of probiotics is effective cannot be made. Moreover, the dose and duration of treatment has not been established. Finally, we do not know whether probiotic treatment should be different according to the type of IBS. Further studies are needed before probiotics can be considered a reliable treatment for IBS.

https://www.ncbi.nlm.nih.gov/pubmed/29291933



"The gut microbiome and irritable bowel syndrome

Abstract
Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders encountered in clinical practice. It is a heterogeneous disorder with a multifactorial pathogenesis. Recent studies have demonstrated that an imbalance in gut bacterial communities, or “dysbiosis”, may be a contributor to the pathophysiology of IBS. There is evidence to suggest that gut dysbiosis may lead to activation of the gut immune system with downstream effects on a variety of other factors of potential relevance to the pathophysiology of IBS. This review will highlight the data addressing the emerging role of the gut microbiome in the pathogenesis of IBS and review the evidence for current and future microbiome based treatments"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039952/

 

And avoiding FODMAPs. Several years ago I saw a piece at Medscape titled "Why telling your IBS patients to just eat more fiber may be bad advice." I immediately clicked because I had long since noticed that certain foods that were high fiber, i.e. apples, were painful to eat. Finally someone had figured it out--at least in my case. Avoiding FODMAPs eliminated most of my IBS symptoms, combined with a couple of probiotics (added years later when I began having increased loose-stools). My gastroenterologist has been using it with many of her patients for years now. See oldish paper explaining it here.

One of the big problems with IBS is that it may well be multiple diseases/conditions that are being lumped together (thanks, in part, to people like Chalder et. al.). There is a clear subgroup that responds well to a lower-FODMAP diet but not all IBS patients do. At the end of the day, we define this disorder based on symptoms, not any biomarker. How do we know those symptoms are all describing the same condition? Given the prevalence of the condition -- 10-20% of the general population -- I find it hard to believe it would be the same thing in all of those people.

The kicker, in my case, is a couple of weeks ago I woke up constipated for the first time in years. After a few days of it not resolving and increasing my FODMAP intake, I finally went and picked an apple from one of the columnar apple trees I have on my balcony (bought around the time I was just learning about FODMAPs). Have been eating apples now just about every day since. Gonna try some milk this week. Go figure. My best crazy speculation at what might be happening is something hormonal as I've probably been in peri-menopause for about a year now. A friend of mine noted that she was suddenly able to eat things she'd not been able to eat for years after menopause. But note, it's just that: crazy speculation. The reality is, who the hell knows why?

 

Articles| Volume 4, ISSUE 11, P863-872, November 01, 2019
Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(19)30243-2/fulltext

 

This is disastrous and completely disqualifies the trial of any conclusions. When nearly half of participants are so disappointed in what they saw that they don't bother responding, that's a sign that you screwed up.

It's seriously remarkable that you can find in the same paragraph that CBT is a recommended treatment but that there is no evidence for its efficacy. This is not even close to be OK, yet so typical of BPS, selling the treatment for years before putting it to the test and then simply using the fact that it had been used for years as a good enough reason to continue despite evidence showing it is useless.

The whole edifice of EBM needs to be torn down, it is so heavily abused it puts the entire field of medicine at risk. Well, actually it's the patients that are put at risk but then if you never ask the question you can claim otherwise, typical BPS BS.

Edit: apparently I repeat myself. Whatever.

 

Not directly related to ACTIB, but should be filed under the same "heads we win, tails we win, we win" in the "eating our cake and having it too" cabinet.

You see, the horrible pandemic lockdown of FEAR FEAR FEAR is what causes Long Covid, but also the peace and quiet of not having to deal with stress outside the house means it's basically like a vacation that solves many "mental health" problems. Or both. Or whatever. It's not as if people eat differently at home or anything like that. Also that FEAR FEAR FEAR was going to cause an epidemic of suicides, or so the leading experts on the topic said, many have talked of a pandemic of mental health crisis. But it also did the opposite. Science is basically whatever you want it to be, I guess.


IBS patients' symptoms improved under COVID-19 lockdown orders
https://www.eurekalert.org/pub_releases/2021-05/ddw-ips051821.php

Bethesda, MD (May 23, 2021) -- Patients' irritable bowel syndrome (IBS) symptoms unexpectedly improved when they were under COVID-19 stay-at-home orders, reaffirming the gut-brain connection in functional gastrointestinal disorders, according to research that was selected for presentation at Digestive Disease Week® (DDW) 2021.

"One of our main hypotheses was that these patients were going to be worse because of pressure and stress due to COVID-19," said Juan Pablo Stefanolo, MD, a lead author on the study and a physician with the Neurogastroenterology and Motility section, Hospital de Clínicas José de San Martín, Buenos Aires University, Argentina. "We think the results have something to do with people staying at home. They were not exposed to outside stress, and at home they were able to avoid food triggers."

Pandemic lockdown orders in Argentina created a unique opportunity for researchers to study the impact of pandemic stressors and reduced social interaction on 129 IBS patients whose pre-pandemic data had already been collected through an earlier research project. The patients were re-assessed during the lockdown with the same online survey that included multiple validated measures of IBS severity, anxiety and depression, along with questions about co-occurring illnesses, including heartburn, regurgitation, indigestion, chronic fatigue, fibromyalgia and nonmigraine headaches.

During the lockdown in Argentina -- one of the longest lockdowns in the world -- the number of patients experiencing severe IBS fell sharply from 65 to 39. The mean Irritable Bowel Syndrome Severity Scale score for the group also fell 66 points, from 278 to 212 on a 500-point scale. IBS symptoms of pain, distention, stool consistency, anxiety, somatization, fibromyalgia and chronic fatigue symptoms all improved during the lockdown.​

A whole 11% uh? On a very imprecise scale, of course. That is veeeery impressive.

Not a small organization either: "Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery".

 

So NIHR is now hyping the null results of ACTIB, basically lying by omission in suggesting "benefits" when there were none. Clearly paving the way for the commercial venture.

https://twitter.com/user/status/1466415612838785031