The Somatic Connection  |   May 2014
G.I. Joe: Could Visceral Osteopathy Help Fight the War against IBS?
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Anna Halbeisen, DO
    Presbyterian Intercommunity Hospital, Downey Campus in California
Article Information
The Somatic Connection   |   May 2014
G.I. Joe: Could Visceral Osteopathy Help Fight the War against IBS?
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 408-409. doi:10.7556/jaoa.2014.079
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 408-409. doi:10.7556/jaoa.2014.079
Attali TV, Bouchoucha M, Benamouzig R. Treatment of refractory irritable bowel syndrome with visceral osteopathy: short-term and long-term results of a randomized trial. J Dig Dis. 2013;14(12);654-661. doi:10.1111/1751-2980.12098.  
Visceral sensitivity is found in 60% of irritable bowel syndrome (IBS) patients and is theorized to contribute to abdominal pain and intestinal motor abnormalities.1-3 Direct palpation, evaluation, diagnosis, and management of the viscera have been used to treat patients since the time of Andrew Taylor Still, MD, DO.4 In 2012, a study by Florance et al5 revealed a greater reduction in IBS severity score and improvement of quality of life with visceral manipulation compared with massage therapy. In 2013, a randomized crossover trial by Attali et al on the same topic used the additional objective measures of rectal sensitivity and colonic transport time. 
Thirty-one voluntary refractory IBS patients participated in Attali et al's study (8 men, 23 women; mean [SD] age and body mass index of 50 [2] years and 25.1 [4.0], respectively). The patients were randomly assigned to group A or group B. Participants in group A received 3 sessions of massage therapy and then 3 sessions of visceral manipulation at 2-week intervals. Participants in group B received the same interventions in reverse order. All techniques were performed by a single osteopath who trained in France and who has a clinical practice in Paris (personal communication, March 2014). The osteopath applied “global” and “local vibratory” techniques to the tender visceral areas as determined by abdominal palpation. The massage therapy used similar hand placements but did not involve visceral manipulation, only abdominal wall massage. 
After massage therapy, participants in group A reported decreased abdominal distention (P=.026) and abdominal pain (P=.001). After visceral manipulation, participants in this group reported further decreased diarrhea (P=.036), abdominal distention (P=.002), and abdominal pain (P=.003). Patients in group B reported improvement in the following symptoms after visceral manipulation: constipation (P=.022), diarrhea (P=.016), abdominal distention (P=.001), and abdominal pain (P=.005). For the same group, no significant differences in symptom severity were reported after massage therapy. Crossover analysis revealed a decrease in self-reported diarrhea (P=.016), abdominal distention (P=.043), and abdominal pain (P=.013) after visceral manipulation. At 1-year follow-up, participants reported persistent amelioration of diarrhea (P=.029), abdominal distention (P=.001), and abdominal pain (P<.001). Visceral manipulation improved rectal sensitivity (P<.05), whereas massage therapy alone did not have a significant effect. Neither treatment had a statistically significant impact on colonic transit time. 
The study of Attali et al supports previous research that has shown visceral osteopathy to be beneficial in patients with IBS. As a well-designed feasibility study, it will enable power analysis to determine appropriate sample size for future clinical trials. Further investigations with objective measures are warranted. 
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(9):1394-1398. [CrossRef] [PubMed]
Grover M, Kanazawa M, Palsson OSet al. Small intestinal bacterial overgrowth in irritable bowel syndrome: association with colon motility, bowel symptoms, and psychological distress [published online May 9, 2008]. Neurogastroenterol Motil. 2008;20(9):998-1008. doi:10.1111/j.1365-2982.2008.01142.x. [CrossRef] [PubMed]
Hebgen E. Viszeralosteopathie – Grundlagen und Techniken. 3rd ed. Stuttgart, Germany: Hippokrates Verlag; 2011.
Lossing K. Visceral manipulation. In: Chila A, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2011:845.
Florance BM, Frin G, Dainese Ret al. Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol. 2012;24(8):944-949. doi:10.1097/MEG.0b013e3283543eb7. [CrossRef] [PubMed]