Irritable bowel syndrome (IBS) has a complex pathology, high prevalence and large impact on patients’ quality of life. As conventional therapy may yield unsatisfactory results, a more holistic approach may be desirable. The current study assessed the effect of micro-physiotherapy on the severity of IBS symptoms.
In a double-blind study, 61 recurrent IBS patients were randomised to two sessions of micro-physiotherapy or sham micro-physiotherapy. Inclusion criteria were the presence of ≥1 IBS symptom from abdominal pain, constipation, diarrhoea or bloating. Exclusion criteria were previous major intestinal surgery and the presence of chronic diseases. The mean patient age was 53.5±15.3 years. Micro-physiotherapy consisted of micro-palpatory examination to identify osteopathic lesions, followed by micro-massage to stimulate self-healing. The control group underwent a sham procedure. The presence and severity of symptoms was assessed at baseline and at 1-month follow-up by the same gastroenterologist.
Two patients did not complete the study. There was a significant difference in percentage of patients that improved after the first session, at 74 % for the micro-physiotherapy group and 38 % for the sham group, respectively (p=0.005). After the second session, the initial improvement was maintained in both groups, although with no further gains, and the differences between the study groups remained significant (p=0.007).
Micro-physiotherapy significantly improves IBS symptoms and should be explored further for use in mainstream healthcare.
The authors thank Dr. Anne-Marie Cahn for the methodological support.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Brun-Strang C, Dapoigny M, Lafuma A, Wainsten JP, Fagnani F. Irritable bowel syndrome in France: Quality of life, medical management, and costs: The Encoli study. Eur J Gastroenterol Hepatol. 2007;19:1097–1103.10.1097/MEG.0b013e3282f1621bSearch in Google Scholar
2. Jones R, Lydeard S. Irritable bowel syndrome in the general population. Bmj. 1992;304:87–90.10.1136/bmj.304.6819.87Search in Google Scholar
3. Saito YA, Schoenfeld P, Locke GR. The epidemiology of irritable bowel syndrome in North America: A systematic review. Am J Gastroenterol. 2002;97:1910–1915.10.1016/S0002-9270(02)04270-3Search in Google Scholar
4. Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001;96:2184–2193.10.1111/j.1572-0241.2001.03961.xSearch in Google Scholar
5. Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: A community survey. Br J Gen Pract. 2004;54:495–502.Search in Google Scholar
6. Spiller RC. Irritable bowel syndrome. Br Med Bull. 2004;72:15–29.10.1002/9781118321386.ch62Search in Google Scholar
7. Amouretti M, Le Pen C, Gaudin AF, Bommelaer G, Frexinos J, Ruszniewski P,et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30:241–246.10.1016/S0399-8320(06)73160-8Search in Google Scholar
8. Camilleri M, Choi MG. Review article: Irritable bowel syndrome. Aliment Pharmacol Ther. 1997;11:3–15.10.1046/j.1365-2036.1997.84256000.xSearch in Google Scholar PubMed
9. Collins SM. Peripheral mechanisms of symptom generation in irritable bowel syndrome. Can J Gastroenterol. 2001;15 Suppl B 14B–16B.10.1155/2001/690794Search in Google Scholar PubMed
10. Collins SM, Piche T, Rampal P. The putative role of inflammation in the irritable bowel syndrome. Gut. 2001;49:743–745.10.1136/gut.49.6.743Search in Google Scholar PubMed PubMed Central
11. Buckley MM, O’Mahony SM, O’Malley D. Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome. World J Gastroenterol. 2014;20:8846–8858.Search in Google Scholar
12. Mulak A, Bonaz B. Irritable bowel syndrome: A model of the brain-gut interactions. Med Sci Monit. 2004;10:55–62.Search in Google Scholar
13. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–1491.10.1053/j.gastro.2005.11.061Search in Google Scholar PubMed
14. Chang FY. Irritable bowel syndrome: The evolution of multi-dimensional looking and multidisciplinary treatments. World J Gastroenterol. 2014;20:2499–2514.10.3748/wjg.v20.i10.2499Search in Google Scholar
15. Wu JC. Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: Facts or myths?. Gastroenterol Hepatol (N Y). 2010;6:705–711.Search in Google Scholar
16. Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. Bmj. 2007;334:1105–1109.10.1136/bmj.39199.679236.AESearch in Google Scholar
17. Cahn AM, Carayon P, Hill C, Flamant R. Acupuncture in gastroscopy. Lancet. 1978;1:182–183.10.1016/S0140-6736(78)90614-1Search in Google Scholar
18. Hagege H. Alternative treatments in irritable bowel syndrome. Gastroenterol Clin Biol. 2009;33(Suppl 1):79–83.Search in Google Scholar
19. Shen YH, Nahas R. Complementary and alternative medicine for treatment of irritable bowel syndrome. Can Fam Physician. 2009;55:143–148.Search in Google Scholar
20. Spanier JA, Howden CW, Jones MP. A systematic review of alternative therapies in the irritable bowel syndrome. Arch Intern Med. 2003;163:265–274.10.1001/archinte.163.3.265Search in Google Scholar PubMed
21. Van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner MJ, Drossman DA,et al. 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;8:46.10.1186/1472-6882-8-46Search in Google Scholar PubMed PubMed Central
22. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. 2011;17:131–139.10.5056/jnm.2011.17.2.131Search in Google Scholar PubMed PubMed Central
23. Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ. Treatment of irritable bowel syndrome with osteopathy: Results of a randomized controlled pilot study. J Gastroenterol Hepatol. 2007;22:1394–1398.10.1111/j.1440-1746.2006.04741.xSearch in Google Scholar PubMed
24. Piche T, Pishvaie D, Tirouvaziam D, Filippi J, Dainese R, Tonohouhan M,et al. Osteopathy decreases the severity of IBS-like symptoms associated with Crohn’s disease in patients in remission. Eur J Gastroenterol Hepatol. 2014;26:1392–1398.10.1097/MEG.0000000000000219Search in Google Scholar PubMed
25. Florance BM, Frin G, Dainese R, Nebot-Vivinus MH, Marine Barjoan E, Marjoux S,et al. Osteopathy improves the severity of irritable bowel syndrome: A pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol. 2012;24:944–949.10.1097/MEG.0b013e3283543eb7Search in Google Scholar PubMed
26. Muller A, Franke H, Resch KL, Fryer G. Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: A systematic review. J Am Osteopath Assoc. 2014;114:470–479.10.7556/jaoa.2014.098Search in Google Scholar PubMed
27. Grosjean D, Benini P. La micropalpation, base de la microkinésithérapie. 1990.Search in Google Scholar
28. Grosjean D. La microkinésithérapie, une thérapie complémentaire?. Profession Kinésithérapeute. 2006;11:14–16.Search in Google Scholar
29. Grosjean D, Benini P. Approche du syndrome algoneurodystrophique du membre supérieur par la microkinésithérapie. Ann Kinésithér. 1990;17:301–304.Search in Google Scholar
30. Grosjean D, Poquin D. Assessment of a microkinesitherapie treatment on 300 low back pain sufferers. Medycyna Manualna. 2006;10:35–46.Search in Google Scholar
31. Pinto Pereira A, Dos Santos Carvalho EM, Ii K, Furman M, Wosh PJA, Gulogurski RL,et al. Assessment of heart rate variability in fibromyalgia after micro-physiotherapy. MTP Rehabil J. 2014;12:191–195 .10.17784/mtprehabjournal.2014.12.189Search in Google Scholar
32. Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: A repeated measures study. Osteopath Med Prim Care. 2008;2:7.10.1186/1750-4732-2-7Search in Google Scholar PubMed PubMed Central
33. Manabe N, Tanaka T, Hata J, Kusunoki H, Haruma K. Pathophysiology underlying irritable bowel syndrome–from the viewpoint of dysfunction of autonomic nervous system activity. J Smooth Muscle Res. 2009;45:15–23.10.1540/jsmr.45.15Search in Google Scholar PubMed
34. Gaynes BN, Drossman DA. The role of psychosocial factors in irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol. 1999;13:437–452.10.1053/bega.1999.0038Search in Google Scholar PubMed
35. Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology. 2013;144:36–49.10.1053/j.gastro.2012.10.003Search in Google Scholar PubMed
36. Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain–gut pathway in functional gastrointestinal disorders is bidirectional: A 12-year prospective population-based study. Gut. 2012;61:1284–1290.10.1136/gutjnl-2011-300474Search in Google Scholar PubMed
37. Koloski NA, Jones M, Talley NJ. Investigating the directionality of the brain-gut mechanism in functional gastrointestinal disorders. Gut. 2012;61:1776–1777.Search in Google Scholar
38. Mach T. The brain-gut axis in irritable bowel syndrome–clinical aspects. Med Sci Monit. 2004;10:125–31.Search in Google Scholar
39. Bonaz B. Inflammatory bowel diseases: A dysfunction of brain-gut interactions?. Minerva Gastroenterol Dietol. 2013;59:241–259.10.1053/j.gastro.2012.10.003Search in Google Scholar
40. Enck P, Martens U, Klosterhalfen S. The psyche and the gut. World J Gastroenterol. 2007;13:3405–3408.10.3748/wjg.v13.i25.3405Search in Google Scholar PubMed PubMed Central
41. Tack J, Fried M, Houghton LA, Spicak J, Fisher G. Systematic review: The efficacy of treatments for irritable bowel syndrome–a European perspective. Aliment Pharmacol Ther. 2006;24:183–205.10.1111/j.1365-2036.2006.02938.xSearch in Google Scholar PubMed
42. Wu JC, Ziea ET, Lao L, Lam EF, Chan CS, Liang AY, et al. Effect of electroacupuncture on visceral hyperalgesia, serotonin and fos expression in an animal model of irritable bowel syndrome. J Neurogastroenterol Motil. 2010;16:306–314.10.5056/jnm.2010.16.3.306Search in Google Scholar PubMed PubMed Central
43. Herman PM, Craig BM, Caspi O. Is complementary and alternative medicine (CAM) cost-effective? A systematic review. BMC Complement Altern Med. 2005;5:11.10.1186/1472-6882-5-11Search in Google Scholar
44. Kaptchuk TJ, Kelley JM, Conboy LA, Davis RB, Kerr CE, Jacobson EE,et al. Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome. Bmj. 2008;336:999–1003.10.1136/bmj.39524.439618.25Search in Google Scholar
45. Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, Singer JP,et al. Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. Plos ONE. 2010;5:15591.10.1371/journal.pone.0015591Search in Google Scholar
46. Spiller RC. Problems and challenges in the design of irritable bowel syndrome clinical trials: Experience from published trials. Am J Med. 1999;107 91S–97S.10.1016/S0002-9343(99)00086-8Search in Google Scholar
© 2017 Walter de Gruyter GmbH, Berlin/Boston