Antidepressants for Functional Esophageal Disorders: Evidence- or Eminence-Based Medicine?

Maradey–Romero, Carla; Fass, Ronnie

doi:10.1016/j.cgh.2014.09.044

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Against this background, acceptance of the undesirable side effects, such as elevated OD risk, is particularly critical. In contrast, concerning the esophageal phase of swallowing, which was not focused on in our study, there are data requiring more controlled trials referring to a positive effect of antidepressants on functional esophageal disorders and chest pain 56 , 57 .…”

Section: Discussionmentioning

confidence: 67%

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs

Wolf

Eckert

Walter³

et al. 2021

Sci Rep

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Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.

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Section: Discussionmentioning

confidence: 67%

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs

Wolf

Eckert

Walter³

et al. 2021

Sci Rep

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“…PPI non-responders, who demonstrate weakly acidic reflux as the underlying cause of their symptom, should be considered for the following therapeutic modalities, transient lower esophageal sphincter relaxation reducers, pro-motility compounds, endoscopic treatment for GERD, and anti-reflux surgery 15 ( Figures 1 and 2 and Table 1 ). As esophageal hypersensitivity has an important role in symptom generation of PPI non-responders with weakly acidic reflux, pain modulators may also provide a therapeutic option 22 , 61 , 62 ( Table 2 ). Non-responders, who demonstrate residual acidic reflux as the underlying cause of their symptoms, should be re-evaluated for lifestyle modifications and proper compliance/adherence as well as considered for other anti-reflux medications such as sucralfate, gaviscon, and H2RAs.…”

Section: Mechanism and Factors Involved In Ppi Failurementioning

confidence: 99%

The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum

Hussain

Henderson

Maradey-Romerao

et al. 2015

Clinical and Translational Gastroenterology

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Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications. Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression. Despite their efficacy, significant proportions of GERD patients are either partial or non-responders to PPI therapy. Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes. This monograph will outline a diagnostic approach to the PPI non-responder, review mechanisms associated with PPI failure, and discuss therapeutic options for those who fail to respond to PPI therapy.

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“…The use of visceral pain modulators may be benefi cial in patients who have functional heartburn or oesophageal hypersensitivity. (44)(45)(46) However, psychological comorbidities can also affect oesophageal perception, resulting in reduced pain thresholds. (45) The use of pain modulators, including tricyclic antidepressants, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, was reported to be benefi cial.…”

Section: Combined Ph-impedance Monitoringmentioning

confidence: 99%

Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy

Ang

How

2016

smedj

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Antidepressants for Functional Esophageal Disorders: Evidence- or Eminence-Based Medicine?

Cited by 5 publications

References 14 publications

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs

Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs

The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum

Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy

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