Dyspepsia

Gastroenterology. 2002 Dec;123(6):1778-85.

Gastroenterology. 2002 Dec;123(6):2132-5.

Gastroenterology. 2003 Aug;125(2):636; author reply 637.
Rev Gastroenterol Disord. 2003 Summer;3(3):182-4.

Long-term improvement in functional dyspepsia using hypnotherapy.

Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ.

Department of Medicine, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom.

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 aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized 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.

Curr Treat Options Gastroenterol. 2003 Aug;6(4):289-297

Treatment of Functional Dyspepsia.

Feinle-Bisset C, Andrews JM.

Department of Medicine, University of Adelaide, Level 6, Eleanor Harrald Building, Frome Road, Adelaide, SA 5000, Australia. christine.feinle@adelaide.edu.au

Because there is currently no universally effective treatment for functional dyspepsia, a stepwise approach is useful. The initial steps should include 1) making a firm clinical diagnosis and providing the patient with appropriate information and reassurance; 2) ascertaining the reason for referral/consultation, as this determines what the patient will regard as a satisfactory outcome; 3) informing the patient that there is no universally effective drug treatment; and 4) giving dietary and general lifestyle advice, such as ingestion of smaller, more frequent meals, a low-fat diet, avoidance of certain foods that may exacerbate symptoms, limiting coffee and alcohol intake, smoking cessation, and stress management techniques. If the initial approach does not provide a satisfactory outcome, the following approaches may be helpful. Psychologic treatment approaches, such as hypnotherapy and/or antidepressants, have shown very encouraging results in recent studies and deserve active consideration. In patients with uninvestigated dyspepsia, the "test and treat" strategy for Helicobacter pylori is a cost-effective approach. Prokinetics are of possible benefit in subjects with delayed gastric emptying; however, the relationship between improvement of gastric emptying and symptom alleviation is weak. Furthermore, it needs to be recognized that treatments directed at acid suppression are generally of little sustained benefit, and that there is ongoing controversy as to whether H. pylori eradication is of direct benefit.

Aliment Pharmacol Ther. 2006 Apr 15;23(8):1241-9.

Prokinetic effect of gut-oriented hypnosis on gastric emptying.

Chiarioni G, Vantini I, DE Iorio F, Benini L.

Department of Gastroenterology, Rehabilitation Hospital of Valeggio s/M, University of Verona, Verona, Italy.

Summary Background No data are available on the effect of hypnosis on gastric emptying. Aim To determine the effect of a hypnosis session on gastric emptying and dyspeptic symptoms. Methods We studied emptying by ultrasonography and epigastric sensations in 11 healthy subjects and in 15 patients affected by functional dyspepsia under three conditions according to a fixed schedule: (a) basal, (b) after cisapride and (c) during a 90 min hypnotic trance. Eight healthy subjects repeated an emptying study listening to relaxing music. Statistical analysis was performed using the Friedman test or RM-anova. Results In dyspeptics, the postprandial increase in the antral area was significantly smaller during the hypnosis trance than under the basal and the cisapride conditions. For the patients gastric emptying was significantly shortened by cisapride, and even more by hypnosis (basal 274 +/- 16.8 min; cisapride 227 +/- 13.2; hypnosis 150 +/- 9.7) whereas for healthy subjects it was shortened only by hypnosis. The repeated study in healthy subjects listening to relaxing music showed no significant difference compared with the basal. Epigastric sensations were improved in dyspeptics by hypnosis, but not by cisapride. Conclusions Gut-oriented hypnosis is effective in shortening gastric emptying both in dyspeptic and in healthy subjects.