Biofeedback for treatment of irritable bowel syndrome

Review Question: We reviewed the evidence for the eFect of biofeedback therapy on the management of irritable bowel syndrome (IBS).

Background: IBS is a common disorder that includes both abdominal pain and changes in stool frequency or consistency. Biofeedback is a therapy in which participants use technology to track a process that is not normally under conscious control (e.g. heart rate, tension of the anal sphincter) in orderto see how relaxed states of mind aFectthese measures. Researchers have proposed that achieving more relaxed states through the tool of biofeedback may help to improve the symptoms of IBS.

Study Characteristics: We searched for studies that compared biofeedback to either no treatment, sham treatment, or to other active treatments for IBS. We reviewed eighttrials thatincluded 300 total participants and assessed the eFect of biofeedback on IBS. Each ofthese studies only included adults, and was carried outin an outpatient setting. The studies ranged from eight weeks to six months in length. The types of biofeedback devices varied, and included heart rate variability, measures of skin temperature or electrical resistance, and the tension of the muscles of the anus.

Study Funding Sources: None of the included trials disclosed funding sources.

Key Results: Our primary clinical outcomes were global clinical improvement and quality of life. Regarding overall improvement, three trials compared biofeedback to no treatment and found that biofeedback as part of a relaxation training program led to better symptom control than no treatment (very low-certainty evidence). Two of these trials also compared biofeedback to an attention control and found minimal symptom improvement, but the eFects of chance could not be ruled out because the evidence was of very low-certainty. One trial found a greater symptom benefit with heart rate biofeedback compared to hypnotherapy (low-certainty evidence). Of two trials comparing biofeedback to counseling, any apparent eFect was minimal and the eFect of chance could not be ruled out (very low-certainty evidence). When rectosigmoidal biofeedback was compared to relaxation control, the eFect favored the relaxation control. The addition of biofeedback to standard medical therapy was superior to medical therapy alone and to medical therapy plus sham biofeedback (low-certainty evidence for both findings).

Quality of Life: A single trial looked specifically at overall quality of life. Quality of life improved both for those in the biofeedback group and those in the cognitive therapy group, but there was no overall diFerence between groups.

Adverse Events: Only one trial explicitly reported on adverse events. It reported no adverse events in either the biofeedback group or the cognitive therapy group.

Certainty of the Evidence: We used the GRADE criteria to assess the certainty of the evidence for each of these findings. These ranged from low to very low. The evidence is current up to July 2019.

Authors' Conclusions: We conclude that the existing data on biofeedback for IBS are limited and leave us uncertain about its value in IBS symptom management. The studies currently available all have design limitations that make the results difficult to apply to clinical settings. We do, however, recommend further study in this area, as biofeedback could represent a unique approach for a difficult to manage condition.