A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia.
OBJECTIVE
This study aimed to determine whether brief psychodynamic-interpersonal (PI) psychotherapy is more efficacious than a psychological control for patients with chronic, intractable functional dyspepsia (FD), and whether patients with abnormal gastric function respond differently than those with normal gastric function.


METHODS
Ninety-five consecutive patients with chronic symptoms of FD who had failed to respond to conventional pharmacologic treatments were approached. Thirty-seven received PI psychotherapy, and 36 the control condition (supportive therapy). Patients completed self-report questionnaires before and after treatment and 12 months later. The patients' gastroenterologists, who were blind to the study groups, conducted independent ratings before and after treatment. Forty-nine patients also underwent a radioisotope gastric emptying study. An intention-to-treat analysis was used with baseline scores as covariates.


RESULTS
At the end of treatment, there were significant advantages for PI psychotherapy compared with controls for the gastroenterologists' (P = 0.002) and patients' total symptom score (P = 0.015). One year after treatment, the symptomatic scores were similar. However, a subanalysis showed that PI therapy was superior to the control condition at 1 year, when patients with severe heartburn were excluded. There was no difference in outcome between patients with normal and abnormal gastric emptying.


CONCLUSIONS
PI therapy may have both short- and long-term effects in patients with dyspepsia, but further evaluation is required. Its cost-effectiveness needs to be determined.
Hamilton
J
J
School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester Royal Infirmary, Manchester, England.
Guthrie
E
E
Creed
F
F
Thompson
D
D
Tomenson
B
B
Bennett
R
R
Moriarty
K
K
Stephens
W
W
Liston
R
R
D000328:Adult; D002908:Chronic Disease; D004415:Dyspepsia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005746:Gastric Emptying; D005762:Gastroenterology / Q000379:methods; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011613:Psychotherapy; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors