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World J Gastroenterol. Jul 7, 2007; 13(25): 3425-3429
Published online Jul 7, 2007. doi: 10.3748/wjg.v13.i25.3425
Placebo responses in patients with gastrointestinal disorders
Frauke Musial, Sibylle Klosterhalfen, Paul Enck
Frauke Musial, Department of Complementary and Integrative Medicine, University Duisburg-Essen, Germany
Sibylle Klosterhalfen, Paul Enck, Deptartment of Psychosomatic Medicine and Psychotherapy, University Hospitals Tübingen, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Frauke Musial, Department of Internal Medicine, Integrative and Complementary Medicine, Kliniken Essen-Mitte, Knappschafts-Krankenhaus, Am Deimelsberg 34a, Essen 45276, Germany. f.musial@kliniken-essen-mitte.de
Telephone: +49-201-8054028 Fax: +49-201-8054005
Received: February 9, 2007
Revised: February 11, 2007
Accepted: March 18, 2007
Published online: July 7, 2007
Abstract

Over the last several years there has been a growing interest in placebo, not only as an inert control in clinical trials, but also in the placebo effect as a group effect as well as a reaction in individual subjects. Methodological factors such as regression to the mean and natural history of the disease play a role in the evaluation of a possible placebo effect. In this report, we discuss several factors including Pavlovian conditioning, beliefs outcome, expectations, and other factors as potential mediators of the placebo response. Placebo effects are common in gastrointestinal diseases and there seems to be no clear difference between placebo effects in functional gastrointestinal diseases (functional dyspepsia and irritable bowel syndrome) and organic gastrointestinal disease (duodenal ulcer and inflammatory bowel disease).

Keywords: Placebo; Gastrointestinal disease; Regression to the mean; Natural history; Pavlovian conditioning; Outcome expectation; Beliefs