The Somatic Connection  |   April 2013
Severity of Irritable Bowel Syndrome Symptoms Is Reduced by Osteopathy
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   April 2013
Severity of Irritable Bowel Syndrome Symptoms Is Reduced by Osteopathy
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 357-358. doi:10.7556/jaoa.2013.113.4.357
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 357-358. doi:10.7556/jaoa.2013.113.4.357
Web of Science® Times Cited: 21
Florance B-M, Frin G, Dainese R, et al. Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol. 2012;24(8):944-949.  
Irritable bowel syndrome (IBS) affects 10% to 20% of the adult and adolescent population,1 but conventional IBS treatments offer minimal clinical benefit. Alternative treatments, including acupuncture, meditation, and herbal medicine, have therefore been attractive treatment options for some patients with IBS.2 Osteopathy, with its focus on the interrelationship of structure and function, is an appealing alternative treatment for functional gastrointestinal disorders such as IBS. To assess the effect of osteopathy on the severity of IBS, researchers from the Department of Gastroenterology at the Centre Hospitalier Universitaire de Nice in Nice, France, conducted a single-blind, randomized sham-controlled trial in which 2 sessions of standardized osteopathy were assessed. 
A total of 30 patients (23 women and 7 men) who met Rome III criteria for IBS were eligible to participate in the study. All patients had IBS symptoms (eg, abdominal pain, discomfort, changes in stool frequency) that were present more than 25% of the time, as measured by patient-recorded data in daily diaries of abdominal and stool symptoms. Criteria for exclusion from the study were celiac disease, inflammatory bowel diseases, lactose intolerance, severe depression and anxiety, thyroid and renal dysfunction, and rheumatologic disease or symptoms. Patients who either were familiar with osteopathy, had previously been treated with osteopathy, or both, were also excluded. Selected patients were randomly assigned (in a 2:1 ratio) to receive either osteopathy (ie, the treatment group [n=20]) or sham osteopathy (ie, the control group [n=10]). 
Patients in the treatment group received two 60-minute sessions of osteopathy that were provided at a 7-day interval. An examination occurred at the start of each session, which I interpret as meaning that the osteopathic maneuvers were individualized to each patient. A standardized osteopathic procedure was provided by the same osteopath. The procedure involved both direct and indirect manipulation directed at the vertebral column, although specific spinal levels were not mentioned. At the end of each session, visceral osteopathy was performed to improve the interconnections between the motions of all organs. The sham procedure performed on patients in the control group involved gentle massage of the spine and abdomen. Follow-up data were collected from both patient groups at day 28 of the study. 
At baseline, no statistically significant differences were noted between the treatment group and the control group with regard to demographic characteristics or IBS symptoms. At day 7 (the day when the second session of osteopathy or sham osteopathy was applied), the treatment group had a statistically significant reduction in the IBS severity score (P=.01) and a statistically significant improvement in quality of life (P=.03), compared with the control group. However, no significant differences were noted at the 28-day follow-up evaluation. An equal reduction in depression and anxiety scores was noted in both patient groups. Stool frequency and consistency were unchanged in both groups. 
The authors of this article acknowledged that the small sample size of their study may have underpowered results related to bowel habits. They also expressed uncertainty that the benefits of osteopathy and sham osteopathy, compared with “usual care,” stemmed from the interaction between the osteopath and the patients with IBS. The authors concluded that osteopathy has a clinical advantage over sham osteopathy in alleviating symptom severity and improving quality of life in patients with IBS, but they also acknowledged that their study did not evaluate the possible benefit of osteopathy provided in multiple treatment doses over an extended period. 
In my experience, IBS symptoms can be virtually eliminated in patients with IBS, when osteopathic manipulative treatment is provided over an extended period of years. The authors speculated that the effect of osteopathic manipulative treatment on the autonomic nervous system was the likely mechanism of action in producing improvements in bowel function. I believe that this speculation is correct but limited, because the osteopathy described in this article did not include upper cervical manipulation, which, in my experience, may improve parasympathetic nervous system function in the gastrointestinal system via cranial nerve X. 
   Section Editor's Note: The following 3 reviews share a theme and were selected to appear in this installment of “The Somatic Connection” because they report a possible benefit of manual therapy and osteopathic manipulative therapy in the treatment of patients with visceral disorders. Osteopathic manipulative treatment has been proven effective in the management of chronic low back pain and is accepted as a beneficial treatment for musculoskeletal disorders in general. In addition, according to the osteopathic tenet of the structure-function relationship, application of osteopathic manipulative treatment has a positive impact on physiological functions and shows benefit in the treatment of systemic disorders (King HH, Jänig W, Patterson MM, eds. The Science and Clinical Application of Manual Therapy. Edinburgh, Scotland: Churchill Livingstone/Elsevier; 2011:301-312.). These 3 studies were also selected because they represent the research of international practitioners of osteopathy and other manual therapy professions, which is relevant to osteopathic medical research on applicable techniques and outcome measurements.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480-1491. [CrossRef] [PubMed]
Hussain Z, Quigley EM. Systematic review: complementary and alternative medicine in the irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(4):465-471. [CrossRef] [PubMed]