The relationship between somatisation and outcome in patients with severe irritable bowel syndrome

Francis Creed, Barbara Tomenson, Elspeth Guthrie, Joy Ratcliffe, Lakshmi Fernandes, Nicholas Read, Steve Palmer, David G. Thompson

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objective: This study aimed to assess the relationship between somatisation and outcome in patients with severe irritable bowel syndrome (IBS). Method: Two hundred fifty-seven patients with severe IBS included in a randomised controlled trial were assessed at baseline and divided into four quartiles on the basis of their somatisation score. The patients were randomised to receive the following over 3 months: brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant paroxetine, or treatment as usual. Outcome 1 year after treatment was assessed using the Short Form-36 physical component summary (PCS) score and total costs for posttreatment year. Results: The patients in the quartile with the highest baseline somatisation score had the most severe IBS, the most concurrent psychiatric disorders, and the highest total costs for the year prior to baseline. At 1 year after the end of treatment, however, the patients with marked somatisation, who received psychotherapy or antidepressant, had improved health status compared to those who received usual care: mean (S.E.) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9), and 26.4 (2.7) for psychotherapy, antidepressant, and treatment-as-usual groups, respectively (adjusted P=.014). Corresponding data for total costs over the year following the trial, adjusted for baseline costs, were £1092 (487), £1394 (443), and £2949 (593) (adjusted P=.050). Conclusions: Patients with severe IBS who have marked somatisation improve with treatment like other IBS patients and show a greater reduction of costs. Antidepressants and psychotherapy are cost-effective treatments in severe IBS accompanied by marked somatisation. © 2008 Elsevier Inc. All rights reserved.
    Original languageEnglish
    Pages (from-to)613-620
    Number of pages7
    JournalJournal of psychosomatic research
    Volume64
    Issue number6
    DOIs
    Publication statusPublished - Jun 2008

    Keywords

    • Antidepressants
    • Health-related quality of life
    • Irritable bowel syndrome
    • Outcome
    • Psychotherapy
    • Somatisation

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