Trance-like states have been recognised for millennia with the term hypnosis being coined by James Braid (1795–1860) a surgeon working in Manchester, England.1 Since that time the technique has moved in and out of fashion and even today is still regarded with some scepticism. However, over the last 25 years there has been a steady stream of studies indicating that in adults gut focused hypnotherapy helps to relieve the symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal disorders with the benefits being sustained for many years.2 Furthermore, in contrast to many pharmacological approaches to these conditions, which often target just one mechanism and consequently one symptom, hypnotherapy frequently improves a wide range of symptoms as well as psychological status and quality of life. It has also been shown that following treatment patients consume less medication and consult less frequently with their general practitioner as well as hospital outpatient departments.2 In addition, the central (brain) processing of noxious peripheral stimuli is amenable to modulation by hypnosis3 and some gastrointestinal physiological events can be similarly influenced.2 Despite all this evidence, it is noteworthy that there has been an apparent reluctance by the medical profession to embrace this form of treatment and its availability within healthcare systems remains sparse in the UK, despite endorsement by National Institute for Health and Clinical Excellence (NICE), and other countries even though there is a progressive demand for it by patients, who are increasingly gaining their information from the internet. Therefore, sufferers often have to seek this form of treatment privately, where the competence of the practitioner cannot necessarily be guaranteed.

One of the most obvious reasons for this lack of enthusiasm for the technique is the fact that its efficacy can never be confirmed in a conventional double-blind controlled trial. Consequently, unless a compromise can be reached about what constitutes an acceptable trial design to resolve this dilemma, it is likely that little progress is going to be made. Similarly, systematic reviewers will continue to conclude that ‘better, well designed studies are needed before any firm conclusions can be drawn’ despite the fact that over 90% of studies published so far, which are admittedly of extremely variable quality, are positive. Another impediment to progress in this field is the lack of a complete understanding of what hypnosis really represents coupled with the bewildering number of techniques that appear to have a hypnotic theme, with protagonists who usually claim that their particular approach is unique in some way. Can it really be that guided imagery, neurolinguistic programming, mindfulness and even approaches such as aromatherapy or reflexology are all completely separate and unrelated? It seems much more likely that they all have some form of common mechanistic basis which has as yet to be defined although some are more closely related than others such as hypnotherapy and guided imagery. Consequently, it was reasonable for Rutten and colleagues,4 to combine the data from studies on hypnotherapy and guided imagery. All the studies included in this review showed that such approaches are just as effective in the paediatric setting and it is interesting to note that in the one study on hypnotherapy, the effects were subsequently shown to be long lasting and there was a strong impression that children are even more responsive to this form of treatment than adults.

This apparent advantage with decreasing age might be explained by some experimental and anecdotal observations from our Unit. In adults we have shown that response to hypnotherapy wanes with age which might suggest that the longer a patient suffers from a functional gastrointestinal disorder, the more entrenched they become in their illness. The alternative explanation that hypnotisability decreases with age is less likely as this seems to be a relatively stable trait and even if it were to decline somewhat, we have shown that response to treatment is not necessarily dependent on hypnotisability. However, it has to be acknowledged that children do have strong imaginations5 and as imagination plays an important part in the hypnotic process this might confer some degree of advantage over adults.

Although we do not see children under the age of 10 in our Unit, we do have some experience in adolescents where we have noticed that the outlook in the majority appears to be far better than in adults and believe that this may be because appropriate education and intervention introduced early in the course of a functional gastrointestinal disorder prevents the build-up of a pattern of illness behaviour. This is because, in addition to pain, bloating and bowel dysfunction, many patients with IBS suffer from a variety of non-colonic symptoms such as backache, lethargy, nausea and bladder symptoms6 and children are no exception to this rule. It is also worth noting that adult females with IBS in secondary care often comment that the pain that they experience is as bad as, or worse than, that of childbirth. Consequently, a child suffering in this way with such a wide range of often severe symptoms is not unreasonably a source of major concern to themselves and, just as importantly, to their parents and both parties need to understand that they must learn to react differently to this alarming situation which otherwise can be made worse by how they respond to it. This educational process is a critical part of the hypnotherapeutic package so the technique can be used to control symptoms and to reduce psychological distress and improve coping skills.

Most adults with IBS admit to symptoms since childhood and once their severity reaches a level requiring referral to secondary care, they frequently continue to suffer for the rest of their lives and become a significant drain on healthcare resources. It is tempting to speculate that early intervention in childhood with a behavioural approach such as hypnotherapy might give an individual the necessary skills to halt this progression and prevent their illness subsequently spiralling out of control. However, choosing which patients might be suitable for such an intervention and its timing is a major challenge, but the prize of actually changing the course of an illness and preventing lifelong suffering is at least worth contemplating.