Turkey Rolls Out Red Carpet For Hamas Chief

As head of NATO's second largest military, Turkish President Recep Tayyip Erdogan has continued to stir controversy among allies by his Hamas-sympathetic stance. As early as last October, just on the heels of the Oct.7 Hamas terror attack, he was bluntly expressing that "Hamas is not a terror organization" but is a "liberation group" rightfully fighting to protect Palestinian lands.

But this weekend he went far beyond mere verbal praise as Turkey's president played official host to Hamas Political Bureau Chief Ismail Haniyeh in Istanbul.

Turkish Presidency via Anadolu

The Saturday meeting saw Erdogan vow to the Hamas chief that Turkey is committed to raising awareness of the plight of the Palestinians on a global stage. He said Turkey will lead the way toward seeing an independent State of Palestine achieved.

"The strongest response to Israel and the path to victory lie in unity and integrity," Erdoğan said, referencing Palestinian political unity at this sensitive moment.

Hamas is the main political rival to Fatah - which is the faction that forms the core of the Palestinian Authority (PA) overseeing the West Bank. While the secular-leaning PA is favored as the Palestinians' representative in the West (and at the UN), Hamas is a designated terror organization in the United States and European Union. So in essence Erdogan just held a state visit for a US-designated terrorist.

Last Wednesday upon officially announcing the Hamas leader's visit, Erdogan had said, "Even if only I, Tayyip Erdogan, remain, I will continue as long as God gives me my life, to defend the Palestinian struggle and to be the voice of the oppressed Palestinian people."

From Tel Aviv's perspective, Erdogan's ratcheting rhetoric in denouncing Israeli 'genocidal' actions will likely been seen as unforgiveable, even after this current crisis is over. Turkey and Israel have long clashed over the Palestinian issue, and these tensions have exploded back into full force. Ties between the two countries are at a historical low point, and have even led to Turkey imposing an export ban on key products for Israel.

Erdogan has all along continued seeking to get Israel branded as a "war criminal" state on the world stage, and is pursuing a case submitted before the the Hague-based International Criminal Court (ICC).

On Saturday Hamas' Haniyeh said Israel is solely to blame for the near collapse of Qatar-mediated truce talks...

In October, as the Gaza war kicked off, Erdogan confirmed he had canceled a planned trip to Israel where he was expected to meet with his Israeli counterpart. This was part of a normalization and restoration of ties effort, which is clearly now indefinitely on ice. It could be years or even decades before ties are healed between the two countries.

https://www.zerohedge.com/geopolitical/nato-member-rolls-out-red-carpet-hamas-chief

Governments Could Stop Inflation If They Wanted... They Will Not

by Daniel Lacalle,

Inflation is no coincidence. It is a policy. Governments, along with their so-called experts, attempt to persuade you that inflation stems from anything other than the consistent, albeit slower, rise in aggregate prices year after year. Issuing more currency than the private sector demands, thus eroding its purchasing power and creating a constant annual transfer of wealth from real wages and deposit savings to the government.

Oil prices are not a cause of inflation but a consequence. Prices increase as more units of the currency used to denominate the commodity shift to relatively scarce assets. Therefore, oil prices do not cause inflation; they are one of the signals of currency debasement. Furthermore, if oil prices caused inflation, we would go from inflation to deflation quickly, not from elevated inflation to slower price increases.

The same goes for all the causes that governments and their agents try to use as an excuse for inflation. Most are just manifestations, not causes of inflation. Even if the global economy were dominated by three evil and stupid oligopolistic businesses, they would not be able to increase aggregate prices and maintain an annual increase if the quantity of currency in the system were to remain equal. Why? Two things would happen. First, those three monopolistic evil corporations would see their working capital soar because citizens would not have enough units of currency to pay for all they produce. Two, the rest of the prices would decline as there would be a significantly lower number of units of currency to purchase other goods and services.

Even a group of quasi-monopolistic corporations cannot make all prices rise in unison and consolidate the annual level, only to continue rising. However, the monopolistic issuer of the currency, the government, can make all prices rise while at the same time diminishing the purchasing power of the units of state debt that they issue.

It is surprising to see how some so-called experts say that a few large corporations make all prices rise but deny that the state that monopolizes the creation of money is the cause of inflation.

The only real cause of inflation is government spending. While banks can generate money -credit- through lending, they rely on projects and investments to support these loans. Banks cannot create money to bail themselves out. No financial entity would go bankrupt then. In fact, banks’ largest asset imbalance comes from lending at rates below the cost of risk and having government loans and bonds as “no-risk” investments, two things that are imposed by regulation, law, and central bank planning. Meanwhile, the state does issue more currency to disguise its fiscal imbalances and bail itself out, using regulation, legislation, and coercion to impose the use of its own form of money.

Monopolies cannot create inflation unless they are able to force consumers to use their products without any decline in demand. We also must understand that destructive and inefficient monopolies can only exist if the state imposes them. In any other situation, those monopolies disappear due to competition, technology, and cheaper imports from other nations. So, which is the only monopoly that can force consumers to use their product regardless of the real demand for it? Government fiat money.

The government is the largest economic agent and therefore the most important driver of aggregate demand, as well as the issuer of currency. The government can end inflation anytime by eliminating the unnecessary spending that causes the deficit, which is the same as money printing. Taxing the private sector to cut inflation is like starving the children to make the fat parent lose weight.

If Senator Warren and President Biden were right and corporations were to blame for inflation, competition, cheaper imports, and a decline in demand, they would have taken care of their unjustified prices. Only the government can cause and perpetuate inflation, using the central bank as its financial arm and regulation as the imposition of the state’s IOU (currency) as the “lowest-risk asset” in banks’ assets. The government creates the currency and imposes it, and when its purchasing power declines, it blames the economic agents that are forced to use its form of money.

MMT defenders and neo-Keynesians say that the government can issue all the currency that they need and that their limit is not fiscal (deficit and debt) but inflation. It makes no sense because inflation is the manifestation of an unsustainable fiscal problem, reflected in the vanishing confidence in the currency issuer. It is, literally, like a giant corporation issuing debt endlessly and thinking nothing matters. It is a subterfuge to implement the constant increase in size of government in the economy, knowing that once it controls a large part, it is virtually impossible to stop the state.

Stephanie Kelton and others say the government should spend all it wants and, if inflation rises, tax the excessive money away. This is funny. So, the government increases size on the way in, spending and diluting the purchasing power of the private sector’s earnings and savings, and then taxes the private sector, thus increasing the size of government on the way out. Furthermore, there is no government that would recognize that inflation comes from spending too much, so the destruction of the private sector continues and the diminishing confidence in the currency extends, as history has proven numerous times.

Governments cannot tax away the inflation they have created by bloating spending. They can only weaken the private productive sector further and worsen the economic situation and the inflation outlook.

There is no such thing as perennial monetary sovereignty. Like any form of debt, currency demand disappears with the government’s solvency and the economic weakness of the private sector consumed by taxes. Once the government destroys confidence in the currency as a reserve of value, the private sector will find some other way to make transactions outside of the imposition of a state-issued currency.

When governments present themselves as the solution to inflation with large spending programs and subsidies, they are printing money, like putting out a fire with gasoline.

Biden says the government has a plan to cut inflation, but all they have done is perpetuate it, making citizens poorer and the productive sector weaker.

If Biden wants to cut inflation, all he must do is eliminate the deficit by cutting expenditures. The reason why governments should never oversee monetary policy and be allowed to monetize all deficits is because no administration will cut its size to defend citizens’ wages because nationalization by inflation and taxes is the goal of interventionism: to create a dependent and hostage economy.

https://www.zerohedge.com/political/governments-could-stop-inflation-if-they-wanted-they-will-not

WHO no longer planning safety alert on Kenvue cough syrup: report

 The World Health Organization is reportedly no longer planning to issue a safety alert on Kenvue's (KVUE) Benylin Paediatric Syrup.

https://seekingalpha.com/news/4092121-who-no-longer-planning-safety-alert-on-kenvue-cough-syrup-report

CRC Screening in Primary Care: The Blood Test Option

 Hi, everyone. I'm Dr Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor.

Kenneth W. Lin, MD, MPH

Last year, I concluded a Medscape commentary on colorectal cancer (CRC) screening guidelines by stating that between stool-based tests, flexible sigmoidoscopy, and colonoscopy, "the best screening test is the test that gets done." But should that maxim apply to the new blood-based screening test, Guardant Health Shield? This proprietary test, which costs $895 and is not generally covered by insurance, identifies alterations in cell-free DNA that are characteristic of CRC.

Shield's test characteristics were recently evaluated in a prospective study of more than 10,000 adults aged 45-84 at average risk for CRC. The test had an 87.5% sensitivity for stage I, II, or III colorectal cancer but only a 13% sensitivity for advanced precancerous lesions. Test specificity was 89.6%, meaning that about 1 in 10 participants without CRC or advanced precancerous lesions on colonoscopy had a false-positive result.

Although the Shield blood test has a higher rate of false positives than the traditional fecal immunochemical test (FIT) and lower sensitivity and specificity than a multitarget stool DNA (FIT-DNA) test designed to improve on Cologuard, it meets the previously established criteria set forth by the Centers for Medicare & Medicaid Services (CMS) to be covered for Medicare beneficiaries at 3-year intervals, pending FDA approval. If public and private payers start covering Shield alongside other CRC screening tests, it presents an opportunity for primary care physicians to reach the approximately 3 in 10 adults between ages 45 and 75 who are not being routinely screened.

A big concern, however, is that the availability of a blood test may cause patients who would have otherwise been screened with colonoscopy or stool tests to switch to the blood test. A cost-effectiveness analysis found that offering a blood test to patients who decline screening colonoscopy saves additional lives, but at the cost of more than $377,000 per life-year gained. Another study relying on three microsimulation models previously utilized by the US Preventive Services Task Force (USPSTF) found that annual FIT results in more life-years gained at substantially lower cost than blood-based screening every 3 years "even when uptake of blood-based screening was 20 percentage points higher than uptake of FIT." As a result, a multidisciplinary expert panel concluded that blood-based screening should not substitute for established CRC screening tests, but instead be offered only to patients who decline those tests.

In practice, this will increase the complexity of the CRC screening conversations we have with patients. We will need to be clear that the blood test is not yet endorsed by the USPSTF or any major guideline group and is a second-line test that will miss most precancerous polyps. As with the stool tests, it is essential to emphasize that a positive result must be followed by diagnostic colonoscopy. To addend the cancer screening maxim I mentioned before, the blood test is not the best test for CRC, but it's probably better than no test at all.

https://www.medscape.com/viewarticle/crc-screening-primary-care-blood-test-option-2024a10007gf

Neuromodulators: Intradermal, Fast-Acting Options on the Horizon

 In the next few years, expect intradermal injections of botulinum toxin A for the improvement in the appearance of pores, sebum, skin texture, and rosacea to gain a foothold in dermatology practices, Jeremy B. Green, MD, predicts.

"This technique is more popular in Asia than it is here in the US," Dr. Green, who practices dermatology in Coral Gables, Florida, said at the Annual Meeting of the American Academy of Dermatology. As opposed to intramuscular injections, "it's an intradermal delivery, so you use numbing cream prior, and you're injecting botulinum toxin A nearly parallel to the skin surface with the bevel of the needle up," he said. "You want to use a precise product. It's uncomfortable delivering volume so superficially due to the tissue distention, so I also use a massager. I inject approximately 0.05 mL to 0.1 mL per point. This does really work."

This mode of delivery was evaluated in a prospective, double-blind, split-face study in South Korea, which enrolled 18 volunteers who received an intradermal injection of botulinum toxin A into one cheek and normal saline into the contralateral side as a control. Participants were between 30 and 54 years of age and were seen at the clinic 2, 4, 8, and 12 weeks after the injection. At each visit, investigators took photographs, used a facial analyzer to evaluate the pores and wrinkles of the infraorbital area, and used a Sebumeter to evaluate sebum secretions from both cheeks. Improvement or aggravation in skin texture was evaluated by both volunteers and clinicians on a numeric scale from –4 (severe aggravation) to +4 (marked improvement) at each visit, and following photographic review, the wrinkle score of the nasolabial fold was graded on a 5-point scale.

The researchers observed no significant effects on the wrinkles of the infraorbital area and on sebum secretion. However, on the side where botulinum toxin A was injected, there were significant improvements in the wrinkles of the nasolabial fold and skin texture, they reported. The effects on nasolabial fold wrinkles lasted 12 weeks, effects on skin texture lasted 8 weeks, and improvement in pore size was only observed at week 2, they wrote. One serious adverse event occurred: a case of facial palsy after the injection of 30 units of botulinum toxin A in one cheek. However, injection of 20 units of botulinum toxin A in one cheek was not associated with any adverse events.

"The duration of these treatments is yet to be determined, but I think this is definitely going to gain popularity in the US," said Dr. Green, clinical assistant professor of dermatology at the University of Miami Department of Dermatology and Cutaneous Surgery.

Recently Approved Neurotoxin

He also discussed letibotulinumtoxinA-wlbg (Letybo), an injectable neurotoxin long used in South Korea, which the US Food and Drug Administration (FDA) approved for the temporary improvement in the appearance of moderate to severe glabellar (frown) lines in adults on March 4, 2024. Approval was based on positive results from three phase 3 trials of letibotulinumtoxinA-wlbg that enrolled more than 1,000 individuals in the United States and Europe.

"This is the sixth approved neurotoxin in the US," Dr. Green said. "It is derived from the CBFC26 strain of Clostridium botulinum, and it's a purified 900 kDa type A toxin complex with human serum albumin and sodium chloride as its excipients." It comes in a 50-unit or 100-unit vial and requires refrigeration. "To me, the most fascinating thing about this product is that it has been the number-one selling botulinum toxin on the South Korea market for the last 5 years," he said. "But what do we know about its characteristics?"

In a non-inferiority trial, Chinese researchers enrolled 500 patients with moderate to severe glabellar wrinkles to investigate the efficacy and safety of letibotulinumtoxinA-wlbg and onabotulinumtoxinA. Participants were randomized 3:1 to receive 20 U of letibotulinumtoxinA-wlbg or onabotulinumtoxinA and then observed them for 16 weeks. The primary endpoint was noninferiority in the proportion of study participants who received a score of 0 or 1 for glabellar wrinkles on a four-point photographic evaluation scale, as assessed by an evaluator at maximum frown at 4 weeks.

At week 4, 88.49% of participants in the letibotulinumtoxinA-wlbg arm achieved a score of 0 or 1 for glabellar wrinkles, compared with 87.39% of those in the onabotulinumtoxinA arm (P = .7469). No significant differences were observed for secondary efficacy or safety endpoints between the two treatments. "It will be interesting to see how this product does when it's available to us," Dr. Green said.

Another potential newcomer is ready-to-use liquid botulinum neurotoxin. RelabotulinumtoxinA is a complex, protein-free, ready-to-use liquid botulinum toxin A designed to avoid the traditional requirement to reconstitute it from powder, according to Galderma. It features a saline phosphate buffer solution, so it contains no human or animal-derived excipients, Dr. Green pointed out, and it eliminates the variability, errors, and risks associated with reconstitution.

"There was a report in the neurology literature of botulinum toxin being reconstituted with sterile water for cervical dystonia," he noted. "When this was injected, it was excruciatingly painful, because it created an osmotic gradient within the muscle. So, if we can take a step away from human error, that would be a good thing."

To date, Dr. Green said, four phase 3 trials of relabotulinumtoxinA involving more than 1,900 patients have been conducted in the United States and Canada evaluating its use for glabellar frown lines and lateral canthal lines, "and the data is impressive," he said. This product is still investigational, said Dr. Green, who has not had experience injecting it in the clinical trial program.

The idea of a rapid onset botulinum toxin is also emerging. TrenibotulinumtoxinE, which is being developed by Allergan, "is similar to a type A neurotoxin," Dr. Green said. "It inhibits neuromuscular transmission via presynaptic vesicular protein synaptosomal-associated protein (SNAP)-25 but at a different cleavage site. It has a faster onset — within one day — but a shorter duration — 3-4 weeks."

In a dose escalation study of its use for glabellar frown lines, 80% of participants achieved a two-grade investigator-rated improvement in glabellar frown line severity at maximum frown at the highest dose. The maximum clinical effect of trenibotulinumtoxinE was seen within 24 hours and lasted between 14 and 30 days.

"The question is, if it is approved by the FDA, where would this product fit in our practices?" Dr. Green asked. "The effect is gone in 3 weeks as opposed to 4 months," so this may be an option to recommend for someone who is reticent to try neurotoxins, he said, "or a patient who comes to you on a Friday and says, 'I have a gala tomorrow night'."

Dr. Green disclosed that he is a consultant to, a speaker for, and/or a member of the advisory board for many pharmaceutical companies, including Allergan and Galderma.

https://www.medscape.com/s/viewarticle/neuromodulators-intradermal-fast-acting-options-horizon-2024a10007ni

Heart Failure, Not Stroke, Most Common Complication of A-Fib

 The lifetime risk of atrial fibrillation (AF) increased from 2000 to 2022 from one in four to one in three, a Danish population-based study of temporal trends found.

Heart failure was the most frequent complication linked to this arrhythmia, with a lifetime risk of two in five, twice that of stroke, according to investigators led by Nicklas Vinter, MD, PhD, a postdoctoral researcher at the Danish Center for Health Service Research in the Department of Clinical Medicine at Aalborg University, Denmark.

Published in BMJ, the study found the lifetime risks of post-AF stroke, ischemic stroke, and myocardial infarction improved only modestly over time and remained high, with virtually no improvement in the lifetime risk of heart failure.

"Our work provides novel lifetime risk estimates that are instrumental in facilitating effective risk communication between patients and their physicians," Dr. Vinter said in an interview. "The knowledge of risks from a lifelong perspective may serve as a motivator for patients to commence or intensify preventive efforts." AF patients could, for example, adopt healthier lifestyles or adhere to prescribed medications, Dr. Vinter explained.

"The substantial lifetime risk of heart failure following atrial fibrillation necessitates heightened attention to its prevention and early detection," Dr. Vinter said. "Furthermore, the high lifetime risk of stroke remains a critical complication, which highlights the importance of continuous attention to the initiation and maintenance of oral anticoagulation therapy."

The Study

The cohort consisted of 3.5 million individuals (51.7% women) who did not have AF as of age 45 or older. These individuals were followed until incident AF, migration, death, or end of follow-up, whichever came first.

All 362,721 individuals with incident AF (53.6% men) but no prevalent complication were further followed over two time periods (2000-2010 and 2011-2020) until incident heart failure, stroke, or myocardial infarction.

Among the findings:

• Lifetime AF risk increased from 24.2% in 2000-2010 to 30.9% in 2011-2022, for a difference of 6.7% (95% confidence interval [CI], 6.5%-6.8%). 
• Lifetime AF risk rose across all subgroups over time, with a larger increase in men and individuals with heart failure, myocardial infarction, stroke, diabetes, and chronic kidney disease. 
• Lifetime risk of heart failure was 42.9% in 2000-2010 and 42.1% in 2011-2022, for a difference of −0.8% (95% CI, −3.8% to 2.2%). 
• The lifetime risks of post-AF stroke and of myocardial infarction decreased slightly between the two periods, from 22.4% to 19.9% for stroke (difference −2.5%, 95% CI, −4.2% to −0.7%) and from 13.7% to 9.8% for myocardial infarction (−3.9%, 95% CI, −5.3% to −2.4%). No differential decrease between men and women emerged. 

"Our novel quantification of the long-term downstream consequences of atrial fibrillation highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with atrial fibrillation," the Danish researchers wrote.

Offering an outsider’s perspective, John P. Higgins, MD, MBA, MPhil, a sports cardiologist at McGovern Medical School at The University of Texas Health Science Center at Houston, said, "Think of atrial fibrillation as a barometer of underlying stress on the heart. When blood pressure is high, or a patient has underlying asymptomatic coronary artery disease or heart failure, they are more likely to have episodes of atrial fibrillation."

According to Dr. Higgins, risk factors for AF are underappreciated in the United States and elsewhere, and primary care doctors need to be aware of them. "We should try to identify these risk factors and do primary prevention to improve risk factors to reduce the progression to heart failure and myocardial infarction and stroke. But lifelong prevention is even better, he added. "Doing things to prevent actually getting risk factors in the first place. So a healthy lifestyle including exercise, diet, hydration, sleep, relaxation, social contact, and a little sunlight might be the long-term keys and starting them at a young age, too."

In an accompanying editorial, Jianhua Wu, PhD, a professor of biostatistics and health data science with the Wolfson Institute of Population Health at Queen Mary University of London, and a colleague, cited the study’s robust observational research and called the analysis noteworthy for its quantification of the long-term risks of post-AF sequelae. They cautioned, however, that its grouping into two 10-year periods (2000-2010 and 2011-2020) came at the cost of losing temporal resolution. They also called out the lack of reporting on the ethnic composition of the study population, a factor that influences lifetime AF risk, and the absence of subgroup analysis by socioeconomic status, which affects incidence and outcomes.

The editorialists noted that while interventions to prevent stroke dominated AF research and guidelines during the study time period, no evidence suggests these interventions can prevent incident heart failure. "Alignment of both randomised clinical trials and guidelines to better reflect the needs of the real-world population with atrial fibrillation is necessary because further improvements to patient prognosis are likely to require a broader perspective on atrial fibrillation management beyond prevention of stroke," they wrote.

In the meantime this study "challenges research priorities and guideline design, and raises critical questions for the research and clinical communities about how the growing burden of atrial fibrillation can be stopped," they wrote.

This work was supported by the Danish Cardiovascular Academy, which is funded by the Novo Nordisk Foundation, and The Danish Heart Foundation. Dr. Vinter has been an advisory board member and consultant for AstraZeneca and has an institutional research grant from BMS/Pfizer unrelated to the current study. He reported personal consulting fees from BMS and Pfizer. Other coauthors disclosed research support from and/or consulting work for private industry, as well as grants from not-for-profit research-funding organizations. Dr. Higgins had no competing interest to declare. The editorial writers had no relevant financial interests to declare. Dr. Wu is supported by Barts Charity. 

https://www.medscape.com/s/viewarticle/heart-failure-not-stroke-most-common-complication-fib-2024a10007nz

Psychological Approaches Calm Functional Digestive Disorders

 Hypnosis, mindfulness meditation, and cognitive-behavioral therapy (CBT) have proven effective in reducing symptoms associated with functional digestive disorders. These psychology-based approaches have shown particular benefits in irritable bowel syndrome (IBS). A presentation at the Francophone Days of Hepatology, Gastroenterology, and Digestive Oncology 2024 discussed these alternative therapies. 

While medication is often ineffective in this indication, behavioral therapies offer an interesting option. "It is important to inform patients about alternative treatments and guide them toward those with the best evidence of efficacy," emphasized Pauline Jouët, MD, PhD, of the department of hepato-gastroenterology at Louis Mourier Hospital in Colombes, France, during her presentation.

Hypnosis Leading the Way

Among functional digestive disorders, IBS is the most common. Due to hypersensitivity of the colon, with or without intestinal motility disorder, it manifests as abdominal pain, constipation, diarrhea, or bloating. This disorder, which can progress in episodes, often significantly affects the patient's quality of life.

The first behavioral therapy to yield promising results in this indication is hypnosis. This approach can help normalize visceral sensitivity and appears to affect intestinal contractions, said Jouët. "It also has an effect on abnormal brain activations in response to painful rectal stimulation."

Hypnosis, when tailored to focus on the digestive system, is now recommended for this indication. "The patient is brought into a specific state of consciousness between wakefulness and sleep, which increases receptivity to suggestion to facilitate psychological and physiological therapeutic changes."

Its benefits were demonstrated in a British study that included more than 1000 patients with IBS that was refractory to medical treatment. After 3 months of weekly hypnosis sessions, 76% of patients experienced symptom improvement, including a significant reduction in pain and bloating.

Encouraging Self-Hypnosis 

These patients also reported improved quality of life. In addition to promoting better bowel movements, the study shows that hypnosis can have a beneficial effect on anxiety and sleep disorders. These effects can be maintained in the long term through self-hypnosis practice, as other studies suggest.

In addition to IBS, hypnosis has also proven effective in managing dyspepsia, a digestive disorder characterized by chronic stomach pain and discomfort. A small, randomized study reported a greater reduction in symptoms among patients treated with hypnosis compared with those treated with medication.

Hypnosis treatment can be conducted in individual or group sessions, either in person or remotely via video conferencing. The practitioner must be trained in this approach. Sessions last between 30 and 60 minutes and cost approximately 50 euros. 

Studies have assessed the effect of 6-12 sessions spaced 1-2 weeks apart. Considering the cost and limited number of trained practitioners, "it is advisable to undergo a few sessions initially to check for improvement and then encourage patients to practice self-hypnosis to try to reproduce the feeling of well-being," said Jouët.

To help patients find a specialist trained in these disorders, the Association of Patients with Irritable Bowel Syndrome provides access to its network of hypnosis practitioners through its website, she added. This site can provide access to individual or group sessions (in person or via video).

CBT for Anxiety

Another recommended therapy is CBT, which has shown good results in managing anxiety and stress triggered by IBS symptoms. "The idea is to correct inappropriate reactions that arise in response to stress," said Jouët. 

Conducted by a psychologist, psychiatrist, or even a gastroenterologist specially trained in the field, sessions aim to explain to the patient the impact of anxiety on symptoms and provide tools to control stress, especially during painful episodes.

A recent Japanese study demonstrated the benefits of CBT in more than 100 patients with moderate to severe IBS refractory to medical treatment. They were randomized to receive, in addition to standard treatment, weekly 90-minute CBT sessions for 10 weeks or be placed on a waiting list (which functioned as a control condition).

At 13 weeks, patients receiving CBT had a decrease in IBS Symptom Severity Score of 115.8 points compared with 29.7 points in the control group. The quality-of-life score was reduced by 20.1 points in the CBT group and 0.2 points in the control group. Benefits were maintained at 27 weeks.

A meta-analysis of nine randomized controlled trials involving 610 patients confirmed the effectiveness of CBT sessions in managing IBS.

The results show a 40% reduction in symptoms compared with the control group (relative risk = 0.60). According to the analysis, "four patients need to be treated with CBT to achieve significant improvement in one patient," said Jouët.

Mindfulness Meditation

Mindfulness meditation has also proven effective in this indication. "The practice of meditation involves focusing on the present moment and taking a step back from one's sensations and thoughts," said Jouët. The goal is to implement adaptation strategies to symptoms to mitigate their effects.

Sessions also aim to provide patients with tools to establish a regular meditation practice. A recent study reported a reduction in symptoms related to the disease in 76% of patients with IBS after 6 months of daily meditation sessions. 

Consisting of eight 2-hour group sessions per week combined with daily individual practice, the Mindfulness-Based Stress Reduction meditation course remains costly. To avoid spending nearly 500 euros, the practitioner recommends directing patients toward less expensive or even free mobile applications.

https://www.medscape.com/viewarticle/psychological-approaches-calm-functional-digestive-disorders-2024a10007na