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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.

Aim: The aim of this study was to explore determinants of residual reflux symptoms among patients with gastroesophageal reflux disease (GERD) despite maintenance treatment with acid suppressive medication (ASM). Methods: Primary care GERD patients on chronic ASM were classified as symptom-free (55%) or symptomatic (45%) according to the impact of their residual reflux symptoms (QolRad). They were compared with respect to lifestyle (BMI, alcohol, smoking, physical exercise), compliance (daily ASM dosage), disease history, psychological factors (SCL-90) and quality of life (SF-36). Results: None of the investigated lifestyle factors, nor dosage and disease history were related to residual symptoms. However, symptomatic patients differed from patients with relief on all psychological and quality of life dimensions. In a multiple logistic regression model somatization, hostility, mental health, body pain, as well as gender were independently associated with residual symptoms; the derived ROC curve had an AUC of 0.78. Conclusions: The majority of GERD patients is symptom-free on chronic ASM; they display a healthy psychological state and high quality of life. Residual symptoms however, are associated with psychological distress and lower quality of life. Recognition of this subgroup might hold the key to improving long-term management of gastroesophageal reflux.

Functional dyspepsia is a common disorder with a diverse pathophysiological background, but the role of motility disorders in functional dyspepsia remains unclear. We aimed to quantify the relationship between disturbed gastric emptying and functional dyspepsia, using a meta-analytic approach. Through a structured literature search of Medline and Embase from 1983 to 1996, we selected all studies in which scintigraphic solid-phase gastric emptying was measured in both functional dyspeptic patients and controls. Seventeen studies involving 868 dyspeptic patients and 397 controls were pooled. Gastric emptying in patients with functional dyspepsia was 1.46 (1.23-1.69) times slower than controls; the proportion of patients with abnormally slow emptying was either 37% (34-40%, simple numeric pooling) or 39% (29-49%, weighted pooling). We conclude that gastric emptying of solids in patients with functional dyspepsia is 1.5 times slower than in healthy controls and that a significant delay of emptying is present in almost 40% of patients with functional dyspepsia.

Background-Dyspepsia is prevalent in about 30% of the general population in Europe, but only 25% of people with complaints consult their general practitioner. Aims-To study the relation between the severity of dyspeptic complaints and the health status of patients presenting to the general practitioner; and the relation with patient characteristics, Helicobacter pylori infection, and psychological distress. Methods-A cross sectional, general practice based survey of 360 unselected primary care dyspeptic patients from 92 general practices in The Netherlands was conducted.Symptom severity was measured using a validated symptom score, H pylori using a whole blood test, and psychological distress using the GHQ-12 test. Functional health status was assessed using the COOP/Wonca charts. Results-Symptoms lasting more than three months and presence of relevant psychological distress were both associated with higher levels of dyspepsia. H pylori infection, frequency of symptoms, and age had no influence on dyspepsia severity. Severity of dyspepsia and psychological distress, but not H pylori infection or duration of symptoms, aVected health status univariately. Dyspepsia correlated with general health, daily activities, and social activities. In logistic modelling, health status was far better predicted by psychological distress than by dyspepsia severity. Conclusion-The relation between dyspeptic symptom severity and health status is limited. H pylori infection relates neither to functional health status, nor to intensity of dyspepsia. Psychological distress is a major determinant of impaired health of dyspeptic patients in general practice and may be the clue to improvement of health status in many dyspeptic patients. (Gut 1999;45:15-19)