Biofeedback for treatment of irritable bowl syndrome

Why is this review important?
Irritable bowel syndrome is a chronic functional disorder associated with abdominal pain, defecation-discomfort, bloating, distention and/or change in bowel habits. It affects around 11% of the population globally with female predominance and out of these approximately 30% consult the physicians. It has association with anxiety and is diagnosed less (25%) in people over 50 years, affecting their quality of life. Irritable bowel syndrome signs can be categorized predominantly as diarrhoea, constipation, or both.

What is it about?
The aim of this Cochrane systematic review was to assess the efficacy and safety of biofeedback-based interventions for irritable bowel syndrome.
It analysed eight randomized controlled trials published in seven articles before July 2019.
Biofeedback is defined as real-time monitoring of an individual's physiological signals which are displayed back to them for improving their health and performance. These signals included (i)temperature fluctuations, (ii)skin-conductance, (iii)heart rate variability, (iv)muscle activity, and (v)respiration patterns.
The studies compared biofeedback intervention (active), with sham biofeedback, psychological counselling, placebo or no-treatment. The analysis included 300 adults diagnosed with irritable bowel syndrome.  
The outcome measures were global clinical improvement in irritable bowel syndrome signs, quality of life, and adverse events (either of biofeedback or cognitive therapy). 

Who is it relevant for?
Individuals with irritable bowel syndrome, their care givers or family, professional working for IBS patients, general physicians, IBS intervention researchers, and policy makers

Key results 
Very low-quality evidence was observed for symptoms control in biofeedback (as part of relaxation training program) compared to no-intervention. Similarly very low-quality evidence was reported in biofeedback group (symptoms-improvement) when compared with attention-control or with psychological counseling. Low-quality evidence was observed for biofeedback in comparison to both standard medical therapy and sham-biofeedback. Suggesting, uncertainty regarding the effectiveness of biofeedback intervention in irritable bowel syndrome

Authors’ conclusions
There is not currently enough good quality evidence to assess whether biofeedback interventions are effective for controlling symptoms of irritable bowel syndrome. Some positive results have been reported about the benefit of biofeedback when used in a- multi-component psychological intervention, compared to a no-treatment control, for clinical symptoms, depression, and anxiety, but in the context of the very low quality of evidence, this effect is uncertain. Biofeedback may reduce irritable bowel syndrome symptoms when compared to hypnotherapy. When compared to counselling, biofeedback does not reduce overall irritable bowel syndrome symptoms or abdominal pain. Biofeedback, when used with standard therapy and compared to standard therapy alone or with sham biofeedback, may lead to an overall symptom reduction.

Future perspective
Existing data on biofeedback for irritable bowel syndrome are limited and uncertain. This approach may support irritable bowel syndrome management but the studies currently available have limitations in study-design. Thus future research is needed with robust design, reporting complete details of blinding, and adverse-events.

Comment by Sunita Gudwani