Clinical trial: predictive factors for response to gut‐directed hypnotherapy for refractory irritable bowel syndrome, a post hoc analysis

Summary Background Gut‐directed hypnotherapy is effective for patients with irritable bowel syndrome (IBS). Despite its considerable evidence base, gut‐directed hypnotherapy is not widely available and remains a limited resource. This emphasises the need to select patients who are most likely to benefit. Aim To determine whether baseline patient characteristics were predictive of response to gut‐directed hypnotherapy in patients with IBS Methods We conducted a secondary analysis of outcomes of 448 patients with refractory Rome III IBS who participated in a randomised study confirming non‐inferiority of 6 compared to 12 sessions of gut‐directed hypnotherapy. We compared baseline patient characteristics, including age, sex, IBS subtype, quality of life and IBS‐Symptom Severity Scale (IBS‐SSS), non‐colonic symptom score and Hospital Anxiety and Depression (HAD) score between responders and non‐responders. We defined response as ≥50‐point decrease in IBS‐SSS or ≥30% reduction in pain severity scores. Results Overall, 76.3% achieved ≥50‐point decrease in IBS‐SSS. Responders had a higher baseline non‐colonic symptom score (p = 0.005). Those who achieved ≥30% improvement in abdominal pain scores (59.8%) had higher baseline IBS‐SSS (p = 0.03), and lower baseline HAD‐depression score (p = 0.012). Fifty‐four patients (12%) dropped out of gut‐directed hypnotherapy. Compared to completers, dropouts had higher baseline HAD‐anxiety score (p = 0.034). Conclusions These data suggest that patients with a higher burden of gastrointestinal and extraintestinal symptoms are most likely to benefit from gut‐specific behavioural intervention for refractory IBS. Clinical assessment of gastrointestinal, somatic and psychological symptom profiles may play a role in selecting patients for gut‐directed hypnotherapy. Clinical response to gut‐directed hypnotherapy for refractory irritable bowel syndrome was associated with higher baseline non‐colonic symptom scores, higher baseline IBS symptom severity and lower baseline depression scores.