Transcript Gut-directed hypnotherapy for functional abdominal pain or irritable

Gut-directed hypnotherapy for
functional abdominal pain or irritable
bowel syndrome in children:
a systematic review
Journal club presentation 30.4.13
Rohini Rattihalli
• Summary of paper
• Critically appraise against checklist
Abstract
• Systematic review to assess efficacy of HT in paediatric
FAP/IBS patients.
• Three RCT comparing HT to a control treatment were
included with sample sizes ranging from 22 to 52
children.
• All trials showed statistically significantly greater
improvement in abdominal pain scores among children
receiving HT.
• Therapeutic effects of HT seem superior to standard
medical care in children with FAP or IBS.
Introduction
• Functional abdominal pain (FAP) and irritable bowel
syndrome (IBS) are characterised by chronic or recurrent
abdominal pain without evidence of any underlying
organic disorder.
• affecting approximately 20% of all children.
• brain–gut axis
• standard medical care: dietary advice, education and
medication.
Methods
• Medline, Embase, PsychINFO, Cumulative Index to
Nursing and Allied Health Literature databases and the
Cochrane Central Register of Controlled Trials
• Search strategy was based on the strategy used by
Webb et al15 in their Cochrane Review.
• reference lists of relevant studies identified in the
literature search were searched by hand
• No language restriction was applied.
• Hypnotherapy/GI
Screening questions
1. Did the review address a clearly focused issue?
– Trials for randomised controlled trials (RCT) in children with FAP
or IBS, investigating efficacy of HT on the following outcomes:
abdominal pain scores, quality of life, costs and school
absenteeism.
2. Did the authors look for the appropriate sort of
papers?
– RCTs
– Hypnotherapy and Guided imagery
3. Do you think that all the important, relevant studies
were included?
– All search terms not mentioned
– References checked
– No language restrictions.
– No mention of
- personal contact with experts
- search for unpublished as well as published studies
4. Did the review's authors do enough to assess the
quality of the included studies
• Delphi criteria and scores: ? Tabulated for exact
criteria met
• Bias
– Randomised
– Similar at baseline
– Person assessing outcomes blind to allocation
5. If the results of the review have been combined, was
it reasonable to do so?
 Not combined
 Different outcomes
 Small numbers
What are the overall results of the review?
• More studies needed!
• Results not pooled
• NNT not expressed (outcome not binary)
• Therapeutic effects of HT seem superior to standard
medical care in children with FAP or IBS.
How precise are the results?
 No CI
Can the results be applied to my patient care?
•No mention of source of patients in individual papers
•Local accessibility for hypnotherapy services
Were all clinically important outcomes considered?
– Costs (and therefore local availability) not assessed
Are the benefits worth the harms and the costs
– No side effects noted.
– Costs not looked into.