Non-Medication Approaches in IBS Offer Paths for Reducing Symptoms

Two non-pharmaceutical approaches for irritable bowel syndrome (IBS) feasibly offered patients symptom relief, according to research presented at the annual Digestive Disease Week meeting.

In a post-hoc analysis of a small single-arm trial, IBS patients’ mean scores on a 0-100 scale dropped from baseline for pain (37 to 21.6), discomfort (48.4 to 27.4), distention (54.8 to 30.9), and bloating (54.4 to 31.8) after 2 weeks of an oral, palatable elemental diet followed by a 2-week follow-up period, reported researchers led by Ali Rezaie, MD, of Cedars-Sinai Medical Center in Los Angeles.

Even after reintroduction of a regular diet, “a 2-week elemental diet significantly improved abdominal pain and other IBS symptoms across subtypes using FDA-recommended responder endpoints,” Rezaie and colleagues wrote in their poster. “Larger, long-term studies are needed to confirm durability and understand how it works.”

And in a sham-controlled randomized trial, people with IBS who used a virtual reality (VR) program to deliver cognitive behavioral therapy (CBT) reported greater symptom improvement after 8 weeks, with scores of 244.3 versus 295.6 with sham on a 0-500 scale where higher numbers indicate more severe symptoms (P=0.026), reported Christopher Almario, MD, of Cedars-Sinai Medical Center, and colleagues.

Researchers noted that “a fully powered efficacy trial is now planned; if proven effective, VR CBT could transform IBS care, substantially expanding access to this evidence-based therapy for millions.”

Palatable Elemental Diet

“Elemental diets provide allergen-free, nutritionally complete formulations with anti-inflammatory and microbiome-modulating properties, yet their effects on IBS have not been well characterized,” according to Rezaie and colleagues.

The researchers conducted a post-hoc analysis of a trial initially designed to assess the tolerability, safety, and effects of an elemental diet (mBiota Elemental) in individuals with small intestinal bacterial overgrowth and/or intestinal methanogen overgrowth.

The 22 participants included in the cohort were those who met the Rome IV criteria for IBS on the first day of enrollment. Participants were 46 years old on average, and 77% were female. A quarter of the participants (23%) had constipation-predominant IBS (IBS-C), 18% had diarrhea-predominant IBS (IBS-D), and the other 59% had mixed type (IBS-M).

After a 1-week baseline screening period, participants for 2 weeks exclusively consumed the oral mBiota Elemental diet — a liquid diet that requires minimal digestive effort, reduces inflammation, and starves invasive bacterial overgrowth, according to the maker — followed by a 2-week reintroduction of their previous regular diet. Participants kept electronic diaries of abdominal pain, discomfort, distention, and bloating.

A reduction in pain of at least 30% was reported in 73% of participants, with 64% experiencing at least a 40% reduction and half experiencing at least a 50% reduction. In addition, 64% of participants experienced at least a 30% reduction in both discomfort and distention, and 59% experienced at least a 30% reduction in bloating.

Overall, 82% of the participants had at least a 30% improvement in at least one symptom, including all of the IBS-C participants, 85% of the IBS-M participants, and 50% of the IBS-D participants.

VR-Delivered CBT

Despite previous research showing CBT’s effectiveness in reducing IBS symptom severity, many people lack access due to a shortage of qualified practitioners and high out-of-pocket costs, said Almario.

The researchers therefore developed SynerGI, a “self-administered virtual reality CBT program that delivers psychoeducation, relaxation strategies, cognitive restructuring, and exposure techniques,” the authors wrote.

The trial enrolled 73 participants with IBS from Cedars-Sinai and the Cleveland Clinic from February to September 2025. The participants all met the Rome IV criteria and had a PROMIS Abdominal Pain T-score of at least 55.

The cohort was predominantly female (65.7%), majority non-Hispanic white (54.7%), and had an average age of 47. The most common IBS subtype among them was IBS-M (45.2%), followed by IBS-D (28.8%), IBS-C (24.7%), and IBS-unclassified (1.4%). At baseline, 63% of participants had severe IBS, denoted by an IBS Symptom Severity Scale (IBS-SSS) score greater than 300.

All participants received a Meta Quest 2 VR headset, with 36 randomly assigned to receive the SynerGI program and 37 randomly assigned to receive a sham VR control that had nature and cityscape videos with classical music. The researchers instructed the participants to use the VR headset for 15 minutes several times a week over 8 weeks.

During the study period, participants using VR CBT used their program for a median 210 minutes, and those in the sham arm used theirs a median 229 minutes. Overall, 78% of those in the CBT group and 89% in the sham group completed the protocol.

Those using SynerGI reported significantly lower scores on the IBS-SSS subscales (0-100) for abdominal pain severity (39.7 vs 52.2 with sham, P=0.036) and for interference of symptoms with daily life (47.4 vs 60.8, P=0.026).

CBT users reported numerically lower scores for the subscales of abdominal pain frequency, abdominal distention or tightness, and dissatisfaction with bowel functioning. The proportion of participants experiencing at least a 6-point decrease on the PROMIS Abdominal Pain scale and who experienced at least a 50-point decrease on the IBS-SSS were each greater in the CBT group, though these differences were also not significant (P=0.81 and P=0.056, respectively).

Scores were also not significantly different between the CBT and sham groups on the IBS-Quality of Life scale (P=0.46) or PROMIS Abdominal Pain T-score (P=0.12).