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Evidence-Based Medicine 2003; 8:160
© 2003 BMJ Publishing Group Ltd.

Economics

Psychotherapy or paroxetine did not reduce abdominal pain, but may improve quality of life in irritable bowel syndrome

Creed F, Fernandes L, Guthrie E, et al.The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.Gastroenterology 2003;124:303–17[CrossRef][Medline]

QUESTION: In patients with severe irritable bowel syndrome (IBS), is psychotherapy or paroxetine more effective than usual care for reducing abdominal pain, and improving health related quality of life (HRQL), without incurring additional costs?

Key Words: antidepressive agents (second generation) • colonic diseases • functional • healthcare costs • paroxetine • psychotherapy

The first 150 words of the full text of this article appear below.

Design
Cost effectiveness analysis of a randomised (allocation concealed*), blinded (clinicians, {data collectors, data analysts, and data safety and monitoring committee}{dagger}),* controlled trial with follow up at 3 and 15 months.

Setting
7 gastroenterology clinics in the UK.

Patients
257 patients 18–65 years of age (mean age 40 y, 80% women) who met Rome I criteria for IBS, had symptoms for >6 months, failed to respond to "usual" medical treatment (antispasmodics and laxatives or antidiarrhoeal medication given for >=3 mo), had severe abdominal pain (visual analogue scale >59), had no contraindication to psychotherapy or paroxetine, and were able to complete the study questionnaires. Follow up was 88% at 3 months; at 15 months, 90% of patients completed pain scores.

Intervention
Patients were stratified by hospital and by pain severity and allocated to psychotherapy (n=85), oral paroxetine, 20 mg daily (n=86), or usual care by a gastroenterologist or general practitioner (n = 86) . . . [Full text of this article]

Filippo Cremonini, MD, Nicholas J Talley, MD, PhD

Mayo Clinic, Rochester, Minnesota, USA






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