Intended for healthcare professionals

Rapid response to:

Primary Care

Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38545.505764.06 (Published 18 August 2005) Cite this as: BMJ 2005;331:435

Rapid Response:

Primary care cognitive behavioural therapy for irritable bowel syndrome: a placebo response only?

The idea of accessible community based treatment of a common disorder
such as irritable bowel syndrome (IBS) is one with great appeal. IBS is
not only common, but it causes much morbidity and cost in terms of
resource utilisation in health services and lost revenue to employers and
employees due to work absences. So it was with great interest that we read
the study by Kennedy et al. But we question whether this study really
demonstrates a beneficial role for cognitive behavioural therapy (CBT) in
the treatment of IBS in the community. Patients randomised to mebeverine
alone were known non-responders to the drug. So any response shown to CBT
over and above mebeverine is as likely to have been a placebo as a real
response. Furthermore, the apparent benefit of CBT over mebeverine alone
lasts only for the duration of the intervention (three months): there is
no difference in symptom score between the two groups thereafter. If so,
the cost-effectiveness of training four nurses for 12 weeks to deliver up
to six weekly 50 minute CBT sessions to provide a temporary placebo
response seems likely to be minimal. The study does, however, provide
reassuring data for future patients who can expect a substantial
improvement in their symptom score over the next 12 months even if they
are initially unresponsive to conventional treatment followed by a two
week trial of mebeverine. Are these nurses going to continue to offer CBT
for IBS in their general practices?

Competing interests:
None declared

Competing interests: No competing interests

13 September 2005
Mark E McAlindon
Consultant Gastroenterologist
D. Paul Hurlstone and David S. Sanders
Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF