← Issue №4/ week of Jul 26, 2026/Motility

In-person therapist-delivered hypnotherapy versus smartphone-based self-guided hypnotherapy in IBS: a multicentre three-armed randomised controlled trial.

From GI Signals issue №4: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

Motility rct · n=230 · Jul 25, 2026 · Gut · IF 24.6

In-person therapist-delivered hypnotherapy versus smartphone-based self-guided hypnotherapy in IBS: a multicentre three-armed randomised controlled trial.

New evidenceIBShealth services
Clinical takeawayConsider smartphone-based self-guided hypnotherapy as a cost-effective alternative for Rome IV IBS patients (16-75 years) when in-person hypnotherapy is unavailable, but counsel that it may be less effective than in-person therapy (33% vs 48% response) and that non-inferiority was not proven.
What it foundSmartphone-based self-guided hypnotherapy had a 33% FDA abdominal pain response rate (≥30% reduction) vs 48% for in-person therapist-delivered hypnotherapy (non-inferiority margin 10% not met: -14.7%, 95% CI -29.3% to 0.9%) and 22% for psychoeducation.
ContextMulticenter RCT in Rome IV IBS patients (16-75 years) confirming in-person hypnotherapy's superiority (48% vs 22% psychoeducation) but showing smartphone-based therapy's meaningful response (33%) despite not meeting non-inferiority.
Emergingsuggested applicable standard· American Academy of Family Physicians (AAFP), "Acute Abdominal Pain in Adults: Evaluation and Diagnosis" (Yew KS, George MK, Allred HB; Am Fam Physician 107(6):585-596), 2023

Decision at stakethe use of hypnotherapy for managing abdominal pain in IBS

Begin evaluation of abdominal pain with a rapid risk assessment: identify hemodynamic instability, signs of peritonitis, or pain out of proportion to examination findings, these patients need urgent resuscitation or surgical evaluation. …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Begin evaluation of abdominal pain with a rapid risk assessment: identify hemodynamic instability, signs of peritonitis, or pain out of proportion to examination findings, these patients need urgent resuscitation or surgical evaluation. Pursue specific life-threatening causes (ruptured AAA, aortic dissection, mesenteric ischemia, ectopic pregnancy, myocardial ischemia) when presentation and risk factors raise suspicion for them, rather than as a universal rule-out before assigning a GI cause. In stable patients, apply a localization-driven differential (RUQ/epigastric/LUQ/RLQ/LLQ/diffuse/periumbilical/suprapubic) with stepwise workup: history and exam with red flags (fever, protracted vomiting, syncope/presyncope, GI blood loss), labs (CBC, CRP, hepatobiliary markers, electrolytes/creatinine/glucose, urinalysis, lipase; pregnancy test in all premenopausal women, including those using reliable contraception; lactate when sepsis or mesenteric ischemia is suspected, may be normal early; ECG/troponin when a cardiac cause is suspected), imaging by location (ultrasound first for RUQ pain; CT with IV contrast for RLQ, LLQ, and generalized pain; CTA when mesenteric ischemia is suspected; in pregnancy, ultrasound first with MRI when ultrasound is inconclusive), then endoscopy and specialty referral by suspicion.

American Academy of Family Physicians (AAFP), "Acute Abdominal Pain in Adults: Evaluation and Diagnosis" (Yew KS, George MK, Allred HB; Am Fam Physician 107(6):585-596), 2023 · reviewed 2026-07-23 ↗
Snijkers JTW … Keszthelyi D · Gut · IF 24.6 · PubMed ↗Permalink
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