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Hamilton J, Guthrie E, Creed F, Thompson D, Tomenson B, Bennett R, Moriarty K, Stephens W, Liston R. A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Gastroenterology. 2000 Sep 1; 119(3):661-9.
BACKGROUND and AIMS: 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.