S. L. Peters

Randomised clinical trial: Gluten may cause depression in subjects with non-coeliac gluten sensitivity - An exploratory clinical study

Current evidence suggests that many patients with self‐reported non‐coeliac gluten sensitivity (NCGS) retain gastrointestinal symptoms on a gluten‐free diet (GFD) but continue to restrict gluten as they report ‘feeling better’.

Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome

A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet is effective in treating irritable bowel syndrome (IBS).

Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease.

Gut‐directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD).

Editorial: gut-directed hypnotherapy or low FODMAP diet for the treatment of irritable bowel syndrome? Authors' reply.

notherapy might be under-estimated as the protocol only included six weekly sessions, which is less in both number and time duration than that used in most other studies. However, data from our own experience indicate that the majority of those responding to hypnotherapy have done so already after 6 weeks. A general weakness in nonpharmacologic IBS interventions is the tendency to include rather a small number of patients, only to involve a few highly specialised centres, and to adopt the use of symptom scales that do not have validated response definitions. This restricts the ability to draw firm conclusions, in terms of generalisability, and represents an obstacle that future IBS research in this field needs to find ways to overcome. The recently published Rome IV guidelines for design of treatment trials in IBS should be encouraged to follow. It seems that we are still following best practice in the care of IBS patients by the use of nonpharmacologic treatment options that local expertise is able to provide, at least when it comes to diet advice and gut-directed hypnotherapy. They reduce IBS symptoms, but predictors of response to any specific therapy are still unclear.

Editorial: Noncoeliac gluten sensitivity - A disease of the mind or gut? Authors' reply

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Editorial: a new shift in the paradigm of treatment for the irritable bowel syndrome?

Treatment strategies for the irritable bowel syndrome (IBS) have changed in recent years. The emergence of high-quality evidence for dietary therapy is leading a paradigm shift towards using diet to control gastrointestinal symptoms, and has given dietitians the clout to command an important place in the multi-disciplinary team managing such patients. Is it time for a further paradigm shift? The audit of a substantial cohort of patients with IBS who have undergone hypnotherapy would suggest so. A clinically significant response of 70% in 1000 consecutive patients is impressive, and supports the positive findings of most randomised studies where hypnotherapy has been compared with supportive treatment. Is such an improvement enough to warrant the widespread uptake of this approach widely? It is easy to criticise this study. It was not placebocontrolled, the durability of benefits was not reported (though have been shown in previous work), and the dependence on the skill of the individual hypnotherapist was not addressed (though the hypnotherapists had at least 5 years’ experience). Adverse effects were not discussed, but gut-directed hypnotherapy is considered exceptionally safe. As it was a single-centre experience, the generalizability of the findings is uncertain, but there are now reports of efficacy from several centres (USA, UK, Sweden and Austria). So why is this therapeutic technique not practised widely? There is a limited skill base, funding for such a labour-intensive therapy is not generally available and, even in mainstream psychology, it has limited acceptance. The randomised clinical trial evidence-base for gut-directed hypnotherapy is also limited because placebos in psychologically based studies are almost impossible to design, to match expectations between treatment and control groups. More studies, especially comparative trials, and the training of more hypnotherapists are required. Perhaps it is time that the gastroenterological community started to embrace gut-directed hypnotherapy for IBS, and prepare for another paradigm shift.