A psychosomatic approach to treatment in the irritable bowel syndrome and peptic ulcer disease with aspects of the design of clinical trials.

Abstract

To compare the effects of conventional medical treatment with treatment that combines medical treatment and psychotherapy, 101 out-patients with irritable bowel syndrome (IBS) and 103 with peptic ulcer disease (PUD) were randomly allocated to two treatment groups. All patients with PUD received medical treatment with antacids and anticholinergics or antacids and H2-receptor antagonists, while the patients with IBS received bulk-forming agents and, when appropriate, anticholinergic drugs, antacids and minor tranquillisers. In addition, the patients in one group with IBS and one group with PUD received dynamically oriented individual psychotherapy in ten hour-long sessions spread over three months. There was a greater improvement in the psychotherapy groups for patients with IBS after three months and for both IBS and PUD patients after 15 months. The difference had become more pronounced after 15 months, with the patients given psychotherapy showing further improvement, and the patients who had received medical treatment only showing some deterioration. In the short-term, the results were more in favour of the psychotherapy group in patients with IBS than PUD, but in the long run, the combination of medical treatment with psychotherapy improved the outcome for both IBS and PUD.