title: Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. What are the real problems for patients with functional dyspepsia? CONTROLLED TRIAL OF HYPNOTHERAPY IN THE TREATMENT OF SEVERE REFRACTORY IRRITABLE-BOWEL SYNDROME The cost‐effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial The value of screening for psychiatric disorders prior to upper endoscopy. A controlled trial of psychological treatment for the irritable bowel syndrome. A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Long-term improvement in functional dyspepsia using hypnotherapy. Distinct profiles of gastritis in dyspepsia subgroups. Their different clinical responses to gastritis healing after Helicobacter pylori eradication. Treating Nonulcer Dyspepsia Considering Both Functional Disorders of the Digestive System and Psychiatric Conditions Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case-control study. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Psychotherapy in functional dyspepsia. The Leeds Dyspepsia Questionnaire: a valid tool for measuring the presence and severity of dyspepsia
abstract: Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms A total of 117 depressed clients , stratified for severity , completed 8 or 16 sessions of manualized treatment , either cognitive-behavioral psychotherapy ( CB ) or psychodynamic-interpersonal psychotherapy ( PI ) . Each of 5 clinician-investigators treated clients in all 4 treatment conditions . On most measures , CB and PI were equally effective , irrespective of the severity of depression or the duration of treatment . However , there was evidence of some advantage to CB on the Beck Depression Inventory ( Beck , Ward , Mendelson , Mock , & Erbaugh , 1961 ) . There was no evidence that CB 's effects were more rapid than those of PI , nor did the effects of each treatment method vary according to the severity of depression . There was no overall advantage to 16-session treatment over 8-session treatment . However , those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions BACKGROUND Patients with functional dyspepsia ( FD ) have more complaints than just the dyspepsia . METHOD One hundred FD patients were assessed with regard to psychologic , medical , and social factors , before r and omization , in a study of cognitive therapy . They were asked to list their main problem areas or ' target complaints ' . RESULTS Dyspepsia was the third most frequent target complaint ( 26 patients ) , and anxiety was the most frequent one ( 65 patients ) . Patients identifying dyspepsia as a target complaint differed from the other FD patients in several aspects . They had significantly more dyspeptic symptoms ( p < 0.05 ) and scored significantly higher on multiple somatic complaints ( p = 0.001 ) , depression ( p = 0.025 ) , general psychopathology ( p = 0.043 ) , the global assessment scale ( p = 0.001 ) , and the General Health Question naire ( p = 0.040 ) . However , they did not have more somatic predisposing factors like consumption of alcohol and coffee or infection with Helicobacter pylori than the patients with other target complaints . CONCLUSIONS Anxiety and not dyspepsia was the most frequent target complaint , and patients who identified dyspepsia as a target complaint did not have more somatic predisposing factors 30 patients with severe refractory irritable-bowel syndrome were r and omly allocated to treatment with either hypnotherapy or psychotherapy and placebo . The psychotherapy patients showed a small but significant improvement in abdominal pain , abdominal distension , and general well-being but not in bowel habit . The hypnotherapy patients showed a dramatic improvement in all features , the difference between the two groups being highly significant . In the hypnotherapy group no relapses were recorded during the 3-month follow-up period , and no substitution symptoms were observed Economic models have suggested that  population Helicobacter pylori screening and treatment may be a cost‐effective method of reducing mortality from gastric cancer . These models are conservative as they do not consider that the programme may reduce health service peptic ulcer and other dyspepsia costs . We have evaluated the economic impact of  population H. pylori screening and treatment  over 2 years in a r and omized controlled trial and have incorporated the results into an economic model exploring the impact of H. pylori eradication on peptic ulcer disease and gastric cancer Gastrointestinal ( GI ) complaints are among the most common symptoms in primary care yet are frequently unexplained and often lead to costly diagnostic testing . We sought to determine the prevalence of psychiatric disorders in patients with unexplained GI complaints undergoing upper endoscopy  , and the likelihood of endoscopic abnormalities in patients with and without psychiatric diagnoses . We prospect ively evaluated 116 adult patients who were undergoing upper endoscopy to evaluate GI complaints . All subjects received a structured psychiatric interview prior to endoscopy using PRIME-MD , and endoscopists were blinded to the PRIME-MD results . Psychiatric disorders were detected in 70 ( 60 % ) patients . Overall , there were 113 diagnoses ( some patients had multiple disorders ) with the most common being somatoform ( 44 % ) , depressive ( 29 % ) , and anxiety ( 19 % ) disorders . Only 29 patients had major endoscopic abnormalities , including esophageal disease ( 14 ) , peptic ulcer ( 9 ) , severe gastritis ( 4 ) , gastric cancer ( 1 ) , and esophageal cancer ( 1 ) . There was a much higher prevalence of psychiatric disorders in patients without major endoscopic abnormalities ( 74 % vs. 21 % , p < 0.0001 ) . Psychiatric disease was strongly predictive of endoscopic findings ( OR for major abnormality = 0.11 in women , and 0.40 in men ) , especially if somatoform disorder was present ( OR = 0.15 ) . We conclude that , with a simple question naire , psychiatric disorders can be diagnosed in a large proportion of patients with unexplained GI complaints who are referred for upper endoscopy . The presence of a psychiatric disorder , particularly if somatoform , makes it unlikely that endoscopy will reveal significant GI disease One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy , relaxation , and st and ard medical treatment compared with st and ard medical treatment alone .  Patients were only selected if their symptoms had not improved with st and ard medical treatment over the previous 6 months . At 3 months , the treatment group showed significantly greater improvement than the controls on both gastroenterologists ' and patients ' ratings of diarrhea and abdominal pain , but constipation changed little . Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress , whereas those with constant abdominal pain were helped little by this treatment . This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to st and ard medical treatment BACKGROUND & AIMS This study aim ed 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 question naires 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 sub analysis 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 BACKGROUND & AIMS We have shown hypnotherapy ( HT ) to be effective in  irritable bowel syndrome  , with long-term improvements in symptomatology and quality of life ( QOL ) . This study aim ed to assess the efficacy of HT in functional dyspepsia ( FD ) . METHODS A total of 126 FD patients were r and omized to HT , supportive therapy plus placebo medication , or medical treatment for 16 weeks . Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase ( short-term ) and after 56 weeks ( long-term ) with 26 HT , 24 supportive therapy , and 29 medical treatment patients completing all phases of the study . QOL was measured as a secondary outcome . RESULTS Short-term symptom scores improved more in the HT group ( median , 59 % ) than in the supportive ( 41 % ; P = 0.01 ) or medical treatment ( 33 % ; P = 0.057 ) groups . HT also benefited QOL ( 42 % ) compared with either supportive therapy ( 10 % [ P < 0.001 ] ) or medical treatment ( 11 % [ P < 0.001 ] ) . Long-term , HT significantly improved symptoms ( 73 % ) compared with supportive therapy ( 34 % [ P < 0.02 ] ) or medical treatment ( 43 % [ P < 0.01 ] ) . QOL improved significantly more with HT ( 44 % ) than with medical treatment ( 20 % [ P < 0.001 ] ) . QOL did improve in the supportive therapy ( 43 % ) group , but 5 of these patients commenced taking antidepressants during follow-up . A total of 90 % of the patients in the medical treatment group and 82 % of the patients in the supportive therapy group commenced medication during follow-up , whereas none in the HT group did so ( P < 0.001 ) . Those in the HT group visited their general practitioner or gastroenterologist significantly less ( median , 1 ) than did those in the supportive therapy ( median , 4 ) and medical treatment ( median , 4 ) groups during follow-up ( P < 0.001 ) . CONCLUSIONS HT is highly effective in the long-term management of FD . Furthermore , the dramatic reduction in medication use and consultation rate provide major economic advantages BACKGROUND A contribution of Helicobacter pylori gastritis to the pathogenesis of non-ulcer dyspepsia ( NUD ) remains uncertain . METHODS Administration of an appropriate clinical question naire followed by endoscopy allowed us to select , among 139 out patients with dyspepsia , 87 non-ulcer dyspepsia patients with more severe and group-distinctive symptoms , 35 of whom were classified as having ulcer-like ( ULD ) . 38 as dysmotility-like ( DLD ) , and 14 as reflux-like dyspepsia ( RLD ) . Biopsy specimens were evaluated for H. pylori gastritis in accordance with the Sydney system . The 70 H. pylori-positive cases were treated with omeprazole , 20 mg twice daily , and amoxycillin , 1 g three times daily for 2 weeks . RESULTS Higher rates of H. pylori colonization were found histologically in the gastric mucosa of ULD ( 91 % ) and RLD ( 86 % ) than in that of DLD ( 68 % ) or asymptomatic ( 42 % ) patients . ULD differed from RLD patients in their higher score of antritis activity . Three and 6 months after H. pylori eradication ULD ( but not DLD ) showed significant regression of dypspetic symptoms scores . CONCLUSIONS It seems likely that H. pylori gastritis , with special reference to active antritis , is among causative factors of ULD . Its role in the pathogenesis of RLD and DLD needs further investigation Nonulcer dyspepsia ( NUD ) is a common syndrome , but the optimal treatments have yet to be established . This study was performed to determine the most effectivetreatment for NUD . Subjects were recruited through the Department of General InternalMedicine at the Kyushu University Hospital because oftheir somatic symptoms . When no organic lesions werefound , the patients were directed to consult ourdepartment ( Psychosomatic Medicine ) ; 194 consecutive NUD patients were studied . All subjects were assessedpsychiatrically with the Structured Clinical Interviewfor DSM-III-R(SCID ) . Patients with serious NUD were hospitalized , and r and omly divided into control(N = 42 ) and experimental groups ( N = 86 ) . The controlswere treated with physical treatment alone . Theexperimental group received psychiatric treatment inaddition , based on the results of SCID . The experimentalgroup showed a significant improvement compared with thecontrols ( P < 0.0001 ) . The treatment for NUD takinginto consideration both the physical and psychiatric conditions is highly effective Non-ulcer dyspepsia , also termed " nervous dyspepsia , " is a heterogeneous syndrome : ulcerlike symptoms can occur with the irritable bowel syndrome , gastroesophageal reflux , and other disorders . In addition , there is a significant subgroup of non-ulcer dyspepsia sufferers who have no disorder associated with , and no known cause for , their dyspepsia , and the dyspepsia in this subgroup is given the provisional name of " essential dyspepsia . " The aim of this study was to assess if psychological factors are associated with patients who present with essential dyspepsia .  Psychometric testing  was carried out on 76 essential dyspepsia patients ( including 18 patients with gastroduodenitis ) , 76 r and omly selected dyspepsia-free community controls ( matched for age , sex , and social class ) , and 66 duodenal ulcer controls .  Essential dyspepsia patients were retested a mean of 3.6 mo later . Using stepwise regression analysis , the initial scores of essential dyspepsia and duodenal ulcer subjects showed them to be more neurotic , anxious , and depressed than community controls ; these abnormalities persisted in essential dyspepsia patients on retesting and were not affected by the symptom status . It is concluded that essential dyspepsia patients who present for investigation with symptoms are more likely to be persistently neurotic , anxious , and depressed than dyspepsia-free controls , and this is unrelated to the presence of symptoms , but the association may not be of major clinical significance , as the numerical differences observed between groups were small and the correlation coefficients were low BACKGROUND & AIMS Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome ( IBS ) , but the cost-effectiveness of either treatment in routine practice has not been established . METHODS Patients with severe IBS were r and omly allocated to receive 8 sessions of individual psychotherapy , 20 mg daily of the specific serotonin reuptake inhibitor ( SSRI ) antidepressant , paroxetine , or routine care by a gastroenterologist and general practitioner . Primary outcome measures of abdominal pain , health-related quality of life , and health care costs were determined after 3 months of treatment and 1 year later . RESULTS A total of 257 subjects ( 81 % response rate ) from 7 hospitals were recruited ; 59 of 85 patients ( 69 % ) r and omized to psychotherapy and 43 of 86 ( 50 % ) of the paroxetine group completed the full course of treatment . Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life ( SF-36 physical component score improvement , 5.2 [ SEM , 1.26 ] , 5.8 [ SEM , 1.0 ] , and -0.3 [ SEM , 1.17 ] ; P < 0.001 ) , but there was no difference in the psychological component . During the follow-up year , psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual ( psychotherapy , $ 976 [ SD , $ 984 ] ; paroxetine , $ 1252 [ SD , $ 1616 ] ; and treatment as usual , $ 1663 [ SD , $ 3177 ] ) . CONCLUSIONS For patients with severe IBS , both psychotherapy and paroxetine improve health-related quality of life at no additional cost Patients with functional dyspepsia were assigned at r and om to cognitive psychotherapy ( 10 sessions of 50 min duration , n = 50 ) or to a control group ( no treatment , n = 50 ) . Before treatment all patients were assessed on psychological , somatic and lifestyle factors . If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ( ' target complaints ' ) . The patients were evaluated at the end of therapy ( after 4 months ) and at 1 yr follow-up . Outcome measures were dyspeptic symptoms , scores on ' target complaints ' and psychological parameters . Both groups showed improvement in dyspeptic and psychological parameters after 1 yr . The improvement in the control group was attributed to a non- specific effect of increased interest and attention . The therapy group showed greater reduction than the control group on dyspeptic symptoms [ days of epigastric pain ( p = 0.050 ) , nausea ( p = 0.024 ) , heartburn ( p = 0.021 ) , diarrhoea ( p = 0.002 ) and constipation ( p = 0.047 ) ] ; and on scores on ' target complaints ' ( p = 0.001 ) There is currently no vali date d question naire that assesses both the presence and severity of dyspepsia
target: Unadjusted data was not statistically significant .
  The other problems of psychological intervention included low recruitment and high drop out rate , which has been shown to be greater in patients receiving group therapy .
  There is insufficient evidence from this review to confirm the efficacy of psychological intervention in NUD
background: BACKGROUND Studies have also shown that non-ulcer dyspepsia ( NUD ) patients have higher scores of anxiety , depression , neurotism , chronic tension , hostility , hypochondriasis and tendency to be more pessimistic when compared with the community controls .
  However , the role of psychological interventions in NUD remains uncertain .
  OBJECTIVES This review aims to determine the effectiveness of psychological interventions including psychotherapy , psychodrama , cognitive behavioural therapy , relaxation therapy and hypnosis in the improvement of either individual or global dyspepsia symptom scores and quality of life scores in patients with NUD .