Current Gastroenterology Reports

, Volume 14, Issue 4, pp 283–289 | Cite as

Meditation over Medication for Irritable Bowel Syndrome? On Exercise and Alternative Treatments for Irritable Bowel Syndrome

  • Fredrick Asare
  • Stine Störsrud
  • Magnus SimrénEmail author
Neuromuscular Disorders of the Gastrointestinal Tract (A Foxx-Orenstein, Section Editor)


Complimentary alternative treatment regimens are widely used in irritable bowel syndrome (IBS), but the evidence supporting their use varies. For psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice. Dietary interventions are commonly included in the management of IBS patients, but these are primarily based on studies assessing physiological function in relation to dietary components, and to a lesser degree upon research examining the role of dietary components in the therapeutic management of IBS. Several probiotic products improve a range of symptoms in IBS patients. Physical activity is of benefit for health in general and recent data implicates its usefulness also for IBS patients. Acupuncture does not seem to have an effect beyond placebo in IBS. A beneficial effect of some herbal treatments has been reported.


Irritable bowel syndrome Cognitive behavioral therapy Gut-directed hypnotherapy Psychodynamic therapy Mindfulness Physical activity Complimentary alternative treatment Diet Probiotics Acupuncture 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–91.PubMedCrossRefGoogle Scholar
  2. 2.
    • Drossman DA, Chang L, Bellamy N, Gallo-Torres HE, Lembo A, Mearin F, Norton NJ, Whorwell P. Severity in irritable bowel syndrome: a Rome Foundation Working Team report. Am J Gastroenterol. 2011;106:1749–59. Study demosntrating how to assess severity in IBS. PubMedCrossRefGoogle Scholar
  3. 3.
    Lovell RM, Ford AC. Global Prevalence of and Risk Factors for Irritable Bowel Syndrome: A Meta-analysis. Clin Gastroenterol Hepatol 2012 [Epub ahead of print].Google Scholar
  4. 4.
    Drossman DA, Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE. Psychosocial aspects of the functional gastrointestinal disorders. Gut. 1999;45 Suppl 2:II25–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Gunnarsson J, Simren M. Peripheral factors in the pathophysiology of irritable bowel syndrome. Dig Liver Dis. 2009;41:788–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Akehurst R, Kaltenthaler E. Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut. 2001;48:272–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Kearney DJ, Brown-Chang J. Complementary and alternative medicine for IBS in adults: mind-body interventions. Nat Clin Pract Gastroenterol Hepatol. 2008;5:624–36.PubMedCrossRefGoogle Scholar
  8. 8.
    Koloski NA, Talley NJ, Huskic SS, Boyce PM. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2003;17:841–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Kong SC, Hurlstone DP, Pocock CY, Walkington LA, Farquharson NR, Bramble MG, McAlindon ME, Sanders DS. The Incidence of self-prescribed oral complementary and alternative medicine use by patients with gastrointestinal diseases. J Clin Gastroenterol. 2005;39:138–41.PubMedCrossRefGoogle Scholar
  10. 10.
    • van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner MJ, Drossman DA, Whitehead WE. Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. BMC Complement Altern Med. 2008;8:46. Careful study demonstrating the use of CAM in patients with functional bowel disorders in a large HMO.PubMedCrossRefGoogle Scholar
  11. 11.
    • Lackner JM, Mesmer C, Morley S, Dowzer C, Hamilton S. Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. J Consult Clin Psychol. 2004;72:1100–13. Well performed meta-analysis of psychological treatments in IBS. PubMedCrossRefGoogle Scholar
  12. 12.
    Drossman DA. Abuse, trauma, and GI illness: is there a link? Am J Gastroenterol. 2011;106:14–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Cho HS, Park JM, Lim CH, Cho YK, Lee IS, Kim SW, Choi MG, Chung IS, Chung YK. Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut Liver. 2011;5:29–36.PubMedCrossRefGoogle Scholar
  14. 14.
    •• Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009;58:367–78. Well performed meta-analysis of psychological treatments in IBS.PubMedCrossRefGoogle Scholar
  15. 15.
    Blanchard EB, Scharff L. Psychosocial aspects of assessment and treatment of irritable bowel syndrome in adults and recurrent abdominal pain in children. J Consult Clin Psychol. 2002;70:725–38.PubMedCrossRefGoogle Scholar
  16. 16.
    Brandt LJ, Bjorkman D, Fennerty MB, Locke GR, Olden K, Peterson W, Quigley E, Schoenfeld P, Schuster M, Talley N. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol. 2002;97:S7–26.PubMedGoogle Scholar
  17. 17.
    Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med. 2003;163:265–74.PubMedCrossRefGoogle Scholar
  18. 18.
    • Lindfors P, Unge P, Nyhlin H, Ljotsson B, Bjornsson ES, Abrahamsson H, Simren M. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome. Scand J Gastroenterol. 2012;47:414–20. Study demonstrating long-term effects of gut-directed hypnotherapy in IBS.PubMedCrossRefGoogle Scholar
  19. 19.
    Ljotsson B, Andersson G, Andersson E, Hedman E, Lindfors P, Andreewitch S, Ruck C, Lindefors N. Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial. BMC gastroenterology. 2011;11:110.PubMedCrossRefGoogle Scholar
  20. 20.
    Moss-Morris R, McAlpine L, Didsbury LP, Spence MJ. A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychol Med. 2010;40:85–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Asare F, Simren M. Mindfulness-based stress reduction in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2011;34:578–9. author reply 579–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Kearney DJ, McDermott K, Martinez M, Simpson TL. Association of participation in a mindfulness programme with bowel symptoms, gastrointestinal symptom-specific anxiety and quality of life. Aliment Pharmacol Ther. 2011;34:363–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Holroyd K. Self-administered cognitive behavior therapy for moderate to severe irritable bowel syndrome: clinical efficacy, tolerability, feasibility. Clin Gastroenterol Hepatol. 2008;6:899–906.PubMedCrossRefGoogle Scholar
  24. 24.
    Ljotsson B, Andreewitch S, Hedman E, Ruck C, Andersson G, Lindefors N. Exposure and mindfulness based therapy for irritable bowel syndrome–an open pilot study. J Behav Ther Exp Psychiatry. 2010;41:185–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Ljotsson B, Falk L, Vesterlund AW, Hedman E, Lindfors P, Ruck C, Hursti T, Andreewitch S, Jansson L, Lindefors N, Andersson G. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome–a randomized controlled trial. Behav Res Ther. 2010;48:531–9.PubMedCrossRefGoogle Scholar
  26. 26.
    • Ljotsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, Rydh S, Ruck C, Lindefors N, Andersson G. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol. 2011;106:1481–91. Pioneering study using the internet to treat patients with IBS.PubMedCrossRefGoogle Scholar
  27. 27.
    Andersson E, Ljotsson B, Smit F, Paxling B, Hedman E, Lindefors N, Andersson G, Ruck C. Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: results from a randomized controlled trial. BMC Public Health. 2011;11:215.PubMedCrossRefGoogle Scholar
  28. 28.
    Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA. Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2010;8:426–32.PubMedCrossRefGoogle Scholar
  29. 29.
    Wallin J, Ringström G, Agerforz P, Asare F, Simren M. Nurse administered gut-directed hypnotherapy in functional bowel disorders: Efficacy and factors predicting a positive response. Gut. 2011;60:A207.Google Scholar
  30. 30.
    • Lindfors P, Unge P, Arvidsson P, Nyhlin H, Bjornsson E, Abrahamsson H, Simren M. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107:276–85. Study demonstrating the usefulness of gut-directed hypnotherapy outside highly specialized hypnotherapy centres. PubMedCrossRefGoogle Scholar
  31. 31.
    Heymann-Monnikes I, Arnold R, Florin I, Herda C, Melfsen S, Monnikes H. The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol. 2000;95:981–94.PubMedGoogle Scholar
  32. 32.
    Svedlund J, Sjodin I, Dotevall G, Gillberg R. Upper gastrointestinal and mental symptoms in the irritable bowel syndrome. Scand J Gastroenterol. 1985;20:595–601.PubMedCrossRefGoogle Scholar
  33. 33.
    Simren M, Mansson A, Langkilde AM, Svedlund J, Abrahamsson H, Bengtsson U, Bjornsson ES. Food-related gastrointestinal symptoms in the irritable bowel syndrome. Digestion. 2001;63:108–15.PubMedGoogle Scholar
  34. 34.
    • Eswaran S, Tack J, Chey WD. Food: the forgotten factor in the irritable bowel syndrome. Gastroenterol Clin North Am. 2011;40:141–62. Review on the role of food in IBS.PubMedCrossRefGoogle Scholar
  35. 35.
    Simren M, Abrahamsson H, Bosaeus I, Brummer RJ, Dolk A, Lindberg G, Nyhlin H, Ohlsson B, Sjolund K, Tornblom H. Nutritional aspects in patients with functional gastrointestinal disorders and motor dysfunction in the gut. Working team report of the Swedish Motility Group (SMoG). Dig Liver Dis. 2007;39:495–504.PubMedCrossRefGoogle Scholar
  36. 36.
    Burden S. Dietary treatment of irritable bowel syndrome: current evidence and guidelines for future practice. J Hum Nutr Diet. 2001;14:231–41.PubMedCrossRefGoogle Scholar
  37. 37.
    • Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204–14. Review on the dietary interventions in IBS.PubMedCrossRefGoogle Scholar
  38. 38.
    Williams EA, Nai X, Corfe BM. Dietary intakes in people with irritable bowel syndrome. BMC Gastroenterol. 2011;11:9.PubMedCrossRefGoogle Scholar
  39. 39.
    Saito YA, Locke 3rd GR, Weaver AL, Zinsmeister AR, Talley NJ. Diet and functional gastrointestinal disorders: a population-based case–control study. Am J Gastroenterol. 2005;100:2743–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Hussain Z, Quigley EM. Systematic review: Complementary and alternative medicine in the irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23:465–71.PubMedCrossRefGoogle Scholar
  41. 41.
    McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008;14:2650–61.PubMedCrossRefGoogle Scholar
  42. 42.
    Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut. 2010;59:325–32.PubMedCrossRefGoogle Scholar
  43. 43.
    • Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25:252–8. Review explaining the FODMAP approach.PubMedCrossRefGoogle Scholar
  44. 44.
    Rogers J, Henry MM, Misiewicz JJ. Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome. Gut. 1989;30:634–41.PubMedCrossRefGoogle Scholar
  45. 45.
    Narducci F, Bassotti G, Granata MT, Pelli MA, Gaburri M, Palumbo R, Morelli A. Colonic motility and gastric emptying in patients with irritable bowel syndrome. Effect of pretreatment with octylonium bromide. Dig Dis Sci. 1986;31:241–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Simren M, Abrahamsson H, Bjornsson ES. An exaggerated sensory component of the gastrocolonic response in patients with irritable bowel syndrome. Gut. 2001;48:20–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Simren M, Agerforz P, Bjornsson ES, Abrahamsson H. Nutrient-dependent enhancement of rectal sensitivity in irritable bowel syndrome (IBS). Neurogastroenterol Motil. 2007;19:20–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.PubMedCrossRefGoogle Scholar
  49. 49.
    Francis CY, Whorwell PJ. Bran and irritable bowel syndrome: time for reappraisal. Lancet. 1994;344:39–40.PubMedCrossRefGoogle Scholar
  50. 50.
    Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. 2000;133:136–47.PubMedGoogle Scholar
  51. 51.
    Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19:245–51.PubMedCrossRefGoogle Scholar
  52. 52.
    Giannini EG, Mansi C, Dulbecco P, Savarino V. Role of partially hydrolyzed guar gum in the treatment of irritable bowel syndrome. Nutrition. 2006;22:334–42.PubMedCrossRefGoogle Scholar
  53. 53.
    Paineau D, Payen F, Panserieu S, Coulombier G, Sobaszek A, Lartigau I, Brabet M, Galmiche JP, Tripodi D, Sacher-Huvelin S, Chapalain V, Zourabichvili O, Respondek F, Wagner A, Bornet FR. The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders. Br J Nutr. 2008;99:311–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Dainese R, Serra J, Azpiroz F, Malagelada JR. Effects of physical activity on intestinal gas transit and evacuation in healthy subjects. Am J Med. 2004;116:536–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Mannerkorpi K. Exercise in fibromyalgia. Curr Opin Rheumatol. 2005;17:190–4.PubMedCrossRefGoogle Scholar
  56. 56.
    Blumenthal JA, Babyak MA, Doraiswamy PM, Watkins L, Hoffman BM, Barbour KA, Herman S, Craighead WE, Brosse AL, Waugh R, Hinderliter A, Sherwood A. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69:587–96.PubMedCrossRefGoogle Scholar
  57. 57.
    Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122:1140–56.PubMedCrossRefGoogle Scholar
  58. 58.
    De Schryver AM, Keulemans YC, Peters HP, Akkermans LM, Smout AJ, De Vries WR, van Berge-Henegouwen GP. Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scand J Gastroenterol. 2005;40:422–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Lustyk MK, Jarrett ME, Bennett JC, Heitkemper MM. Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome? Gastroenterol Nurs. 2001;24:129–37.PubMedCrossRefGoogle Scholar
  60. 60.
    Kim YJ, Ban DJ. Prevalence of irritable bowel syndrome, influence of lifestyle factors and bowel habits in Korean college students. Int J Nurs Stud. 2005;42:247–54.PubMedCrossRefGoogle Scholar
  61. 61.
    • Johannesson E, Simren M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011;106:915–22. Pioneering study assessing physical activity as a treatment option in IBS.PubMedCrossRefGoogle Scholar
  62. 62.
    Oettle GJ. Effect of moderate exercise on bowel habit. Gut. 1991;32:941–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Villoria A, Serra J, Azpiroz F, Malagelada JR. Physical activity and intestinal gas clearance in patients with bloating. Am J Gastroenterol. 2006;101:2552–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Moses FM. The effect of exercise on the gastrointestinal tract. Sports Med. 1990;9:159–72.PubMedCrossRefGoogle Scholar
  65. 65.
    Posserud I, Agerforz P, Ekman R, Bjornsson ES, Abrahamsson H, Simren M. Altered visceral perceptual and neuroendocrine response in patients with irritable bowel syndrome during mental stress. Gut. 2004;53:1102–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner MR, Gandevia SC, Gomez-Pinilla F, Greenwood BN, Hillman CH, Kramer AF, Levin BE, Moran TH, Russo-Neustadt AA, Salamone JD, Van Hoomissen JD, Wade CE, York DA, Zigmond MJ. Neurobiology of exercise. Obesity. 2006;14:345–56.PubMedCrossRefGoogle Scholar
  67. 67.
    • Manheimer E, Wieland LS, Cheng K, Li SM, Shen X, Berman BM, Lao L. Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis. Am J Gastroenterol 2012 [Epub ahead of print]. Excellent review on acupuncture in IBS. Google Scholar
  68. 68.
    Liu JP, Yang M, Liu YX, Wei ML, Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2006:CD004116.Google Scholar
  69. 69.
    Tovey P. A single-blind trial of reflexology for irritable bowel syndrome. Br J Gen Pract. 2002;52:19–23.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Fredrick Asare
    • 1
    • 2
  • Stine Störsrud
    • 1
  • Magnus Simrén
    • 1
    • 2
    Email author
  1. 1.Department of Internal Medicine and clinical nutrition, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  2. 2.University of Gothenburg Centre for Person-Centered Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden

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