Trial Identifies Few Predictors of Response to Internet-Delivered IBS Treatment

In an exploratory secondary analysis of a randomized controlled trial involving 350 participants, researchers found no robust or consistent predictors of clinically meaningful improvement in symptoms or quality of life following a multidisciplinary internet-delivered intervention for irritable bowel syndrome. The investigators evaluated whether baseline patient characteristics and treatment-related factors could anticipate clinical benefits, but the results demonstrated limited overall utility for forecasting which individuals are most likely to improve.

The secondary analysis drew upon data collected during a randomized controlled trial comparing internet-delivered cognitive behavioral therapy, a low-FODMAP diet, or a combined approach against patient education. Candidate predictors were selected pragmatically by the researchers based on their potential clinical relevance to patient outcomes.

To measure therapeutic benefits, the research team established a primary outcome defined as achieving a reduction of at least 50 points on the Irritable Bowel Syndrome Severity Scoring System. Two secondary outcomes were additionally monitored to capture broader clinical improvements: a reduction of at least 30 percent on the Irritable Bowel Syndrome Severity Scoring System and an increase of at least 14 points on the Irritable Bowel Syndrome Quality of Life measure. The investigators evaluated these endpoints using univariable and multivariable logistic regression models to assess potential statistical associations.

Multivariable analyses revealed mixed associations with the primary outcome benchmark. Participants with more severe baseline irritable bowel syndrome symptoms and higher baseline quality of life scores exhibited increased odds of achieving a 50-point or greater symptom score reduction. Conversely, longer symptom duration and a history of poor treatment effect from a FODMAP diet were associated with reduced odds of reaching that threshold. When researchers incorporated treatment-related factors into the multivariable framework, adherence to patient education was associated with increased odds of achieving the primary 50-point symptom reduction.

For the secondary outcomes, multivariable models that included treatment-related factors demonstrated that a prior poor treatment response to a FODMAP diet was associated with reduced odds of achieving a 30 percent symptom reduction, while higher baseline quality of life was associated with reduced odds of experiencing an increased quality of life score. Across all evaluated outcomes, the proportion of variance explained by the regression models remained low to modest. Noting that a prior poor response to the FODMAP diet was linked to reduced odds of symptom improvement across both responder definitions, the authors concluded that previous treatment experiences remain important to consider, even as individual response remains difficult to forecast without further research into more robust predictors and underlying mechanisms of change.

The clinical trial evaluating these multidisciplinary approaches was registered at ClinicalTrials.gov under identifier NCT06117865 on October 31, 2023.

Subject of Research: Predictors of treatment response in internet-delivered interventions for irritable bowel syndrome

Article Title: Predictors of response to a multidisciplinary internet-delivered intervention for irritable bowel syndrome: an explorative secondary analysis of a randomized controlled trial

Article References: Thuen, C., Dear, B., Kenter, R. M. F., Steinsvik, E. K., Vikøren, L. A. S., Lied, G. A., & Berentsen, B. (2026). Predictors of response to a multidisciplinary internet-delivered intervention for irritable bowel syndrome: an explorative secondary analysis of a randomized controlled trial. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05522-w

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05522-w

Keywords: irritable bowel syndrome, internet-delivered interventions, cognitive behavioral therapy, FODMAP diet, patient education, treatment response, randomized controlled trial, gastroenterology, Predictors, response, multidisciplinary, internet-delivered