Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis.

Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain-gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain-gut behaviour therapy.

一些特定的疗法，如针对IBS的认知行为疗法(CBT)或肠道导向的催眠疗法，具有特定的技术，因此它们自成一类脑-肠行为疗法，而其他如压力管理和放松训练等技术则较为常见或普遍，存在于大多数脑-肠行为疗法类别中。

In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain-gut behaviour therapies.

此外，还包括其他行为疗法或治疗选项，例如数字疗法，这些并不被归类为脑肠行为疗法。

We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.

我们的目标是评估现有行为疗法在肠易激综合症中的相对疗效。

Methods

For this systematic reviewand network meta-analysiswe searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention.

在这项系统评价和网络荟萃分析中，我们从创建至2025年4月23日，检索了MEDLINE、EMBASE、EMBASE经典、PsychINFO和Cochrane中央控制试验登记处，以确定比较成人肠易激综合症(IBS)行为疗法之间或与对照干预措施的随机对照试验(RCTs)。

We judged efficacy using dichotomous assessments of improvement in global IBS symptoms.

我们使用二元评估来判断全球IBS症状改善的疗效。

We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs.

我们使用随机效应模型汇总数据，每种干预措施的效果报告为汇总相对风险（RRs）及其95%置信区间。

We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.

我们根据行为疗法的P分数对它们进行排名，P分数是每种治疗比其他所有竞争性行为疗法更好的平均确定程度的平均值。

Results

We identified 67 eligible RCTs, comprising 7441 participants.

我们确定了67项符合条件的随机对照试验(RCTs)，共包含7441名参与者。

After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39-0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41-0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43-0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53-0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50-0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61-0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66-0·95], P score 0·39; 12 trials, 1507 patients).

治疗完成后，与等待名单对照组相比，显示出有效性的行为疗法包括：最小接触认知行为疗法(CBT)（治疗后首次随访时全球肠易激综合症(IBS)症状未改善的相对风险(RR)为0.55 [95% 置信区间(CI) 0.39-0.76]，P得分为0.78；两项随机对照试验(RCTs)，511名患者），电话疾病自我管理（0.57 [0.41-0.80]，P得分为0.75；两项试验，746名患者），动态心理治疗（0.59 [0.43-0.80]，P得分为0.72；三项RCTs，303名患者），认知行为疗法（CBT）（0.65 [0.53-0.80]，P得分为0.64；九项试验，1150名患者），疾病自我管理（0.68 [0.50-0.92]，P得分为0.58；三项RCTs，375名患者），基于互联网的最小接触CBT（0.77 [0.61-0.96]，P得分为0.43；五项RCTs，705名患者），以及针对肠道的催眠疗法（0.79 [0.66-0.95]，P得分为0.39；12项试验，1507名患者）。

After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28-0·94] and 0·50 [0·26-0·96], respectively) and routine care (0·46 [0·31-0·69] and 0·45 [0·24-0·85], respectively), and group CBT (0·50 [0·29-0·86]), internet-based minimal contact disease self-management (0·58 [0·40-0·86]), and dynamic psychotherapy (0·61 [0·44-0·86]) were all superior to routine care.

治疗完成后，在仅招募难治性症状患者的研究中，电话疾病自我管理和应急管理工作均优于注意力安慰剂对照组（0.52 [95% CI 0.28-0.94] 和 0.50 [95% CI 0.26-0.96]，分别）和常规护理（0.46 [95% CI 0.31-0.69] 和 0.45 [95% CI 0.24-0.85]，分别），以及C组认知行为疗法（0.50 [95% CI 0.29-0.86]）、基于互联网的最小接触疾病自我管理（0.58 [95% CI 0.40-0.86]）和动态心理治疗（0.61 [95% CI 0.44-0.86]）均优于常规护理。

Analyses for global IBS symptoms at first point of follow-up post-treatment, and for global IBS symptoms at first point of follow-up post-treatment when behavioural therapies were studied according to treatment class, showed evidence of publication bias when compared with waiting list control.

对治疗后首次随访时的全球肠易激综合症（IBS）症状进行分析，以及对行为疗法根据治疗类别进行研究时的治疗后首次随访时的全球IBS症状进行分析，与等待列表对照组相比，显示了出版偏倚的证据。

The Cochrane risk of bias tool indicated that no RCT was at low risk of bias across all domains.

科克兰偏倚风险工具显示，没有任何随机对照试验在所有领域都处于低偏倚风险。

interpretation

Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain-gut behaviour therapies.

几种行为疗法对肠易激综合征的全身症状有效，尽管对于被归类为脑-肠行为疗法的证据最为充分。

However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.

然而，由于部分出版偏倚和纳入试验的偏倚风险，网络中所有直接和间接比较的证据确定性被评为低或非常低的置信度。

funding

None.

无。