Treatment

Joshua Z. Goldenberg, ND, on Biofeedback Therapy for Treating IBS

Biofeedback is a type of mind-body therapy used to better understand the physiologic functions of the body. Its use for the treatment for gastrointestinal disorders, though, is uncertain.

A recent study1 aimed to assess the efficacy and safety of biofeedback-based interventions for treating irritable bowel syndrome (IBS) among adults and children. To gain more insight, Gastroenterology Consultant reached out to the lead author, Joshua Z. Goldenberg, ND, who is a naturopathic doctor at the Goldenberg GI Center, LLC, a research investigator at Helfgott Research Institute, and founder of Dr. Journal Club, LLC.

GASTRO CON: What are some examples of biofeedback therapy? Are there other GI conditions where it has been proven useful and/or safe? 

Joshua Goldenberg: There are many types of biofeedback. One of the more common types is heart rate variability biofeedback, and a different type is commonly used in dyssynergic defecation.2  Overall, there is mixed evidence on the use of biofeedback for gastrointestinal conditions, though.

GASTRO CON: What prompted you to conduct your study? 

JG: I am very interested in IBS and was curious about various intervention types that may benefit patients. IBS is extremely common among the global population (with the prevalence rate estimated between 10% to 25%3) and any light we could shed on treatment options we hoped would be helpful for patients and providers. 

GASTRO CON: Most of the clinical benefit findings from your study were “uncertain.” Why do you think this is? 

JG: We used recently published guidelines for determining the language to use to describe our findings.4 The language choice, including stressing uncertainty, is due to both the size of the effect estimate and certainty we have in the effect estimate (using GRADE criteria). Due to limitations in the evidence base (primarily issues of risk of bias and imprecision), the certainty we have in our effect estimates were low and very low. For this reason, the language we used to describe our findings stressed the uncertainty in the effect estimates. 

GASTRO CON: What were the most important findings from your study? 

JG: There is currently not enough evidence to assess whether biofeedback interventions are effective for controlling symptoms of IBS. However, a handful of small studies are promising. Moreover, with the recent focus of Rome IV5 on viewing IBS (and functional bowel disorders in general) as a disorder of gut-brain interaction, biofeedback might be of particular interest to gastroenterologists. 

GASTRO CON: What are the next steps in the research needed to determine whether biofeedback is beneficial for IBS management? 

JG: Future research should include active control groups that use high provider-participant interaction, in an attempt to balance nonspecific effects of interventions (placebo effects) between groups and report both commonly used outcome measures (eg, IBS-SSS) and historical outcome measures (eg, the composite primary symptom reduction score) to allow for meta-analysis with previous studies. Future studies should be explicit in their reporting of adverse events.

References:

  1. Goldenberg JZ, Brignall M, Hamilton M, et al. Biofeedback for treatment of irritable bowel syndrome [published online November 12, 2019]. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012530.pub2.
  2. Woodward S, Norton C, Chiarelli P. Biofeedback for treatment of chronic idiopathic constipation in adults [published online March 26, 2014]. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd008486.pub2.
  3. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014;6:71-80. https://dx.doi.org/10.2147%2FCLEP.S40245.
  4. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, eds. Cochrane Handbook for Systematic Reviews of Interventions. 6th ed. Cochrane; 2019. www.training.cochrane.org/handbook.
  5. Drossman DA, Hasler WL. Rome IV – Functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6):1257-1261. https://doi.org/10.1053/j.gastro.2016.03.035.