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Psychological interventions may be slightly superior to usual care or waiting list control conditions at the end of treatment although the clinical significance of this is debatable. Except for a single study, these therapies are not superior to placebo and the sustainability of their effect is questionable. The meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. Future research should adhere to current recommendations for IBS treatment trials and should focus on the long-term effects of treatment.

Functional dyspepsia is a common disorder in primary care and gastroenterology units; however, the pathophysiology is poorly understood. Delayed gastric emptying is present in nearly 40% of patients. We evaluated the validity of the paracetamol absorption test in comparison with scintigraphy for gastric emptying assessment. Studies comparing scintigraphy with paracetamol absorption were selected through a structured Medline search. A correlation coefficient between scintigraphy and paracetamol absorption over 0.6 was considered good, between 0.45 and 0.6 intermediate, and below 0.45 poor. Feasibility was assessed by studying the administration of paracetamol, frequency of blood sampling, duration of the test period, and parameters used in the analysis. Thirteen studies were identified, eight (127 subjects) found a good correlation between scintigraphy and paracetamol absorption, two studies (28 subjects) found a moderate correlation, and three (25 subjects) found no correlation. Parameters used were area under the curve (N = 9), fixed-time concentrations (N = 6), concentration-max (N = 4) and time-to-concentration-max (N = 5). Repetitive blood samples ranged from 6 to 20 samples. The durations were 1.5-8 h. In conclusion, the paracetamol absorption technique generally correlates well to scintigraphy of liquid phase gastric emptying. The execution and outcome parameters however need further standardization to optimize its' value for clinical use and research purposes.

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Background: Despite evidence of the overuse of acid suppressive medication for gastroesophageal reflux disease (GERD), a transfer to noncontinuous therapy after long-term treatment proves difficult. Aim: To quantify the effect of blinded dosage reduction after long-term therapy on symptom control and quality of life while assessing pharmacological and placebo needs. Methods: Primary care patients with a history of GERD and long-term treatment were randomized to daily placebo with pantoprazole rescue (n = 141) or daily pantoprazole with placebo rescue (n = 62) upon relief after 4 weeks pantoprazole 20 mg. The number of rescue tablets, symptom control and generic quality of life were analyzed. Results: Measured from the daily placebo arm, 19% of the patients terminated treatment, 33% managed with 2–6 tablets/week, 38% needed a daily dosage and 10% needed more than a daily dosage in the long run. At these final dosages, symptom control and quality of life were dosage-independent and, furthermore, equal to values of patients on fixed daily pantoprazole. A temporal decrease in well-being was seen in 24% of the patients. Conclusion: A significant placebo response is apparent in long-term users of acid suppressive medication and pharmacological dependency is overestimated. Despite their history of long-term treatment, the majority of GERD patients can be switched from daily to on-demand treatment without impairing symptom control and quality of life.