Effect of citalopram on esophageal motility in healthy subjects—Implications for reflux episodes, dysphagia, and globus

Abstract

Background Drugs such as citalopram, “targeting” the serotonin pathway, can alter esophageal mechano‐chemical sensitivity and gastrointestinal motility. The aim of this study was to clarify the effect of citalopram on esophageal motility and sphincter function, transient lower esophageal sphincter relaxations (TLESRs), and reflux events. Methods Sixteen healthy volunteers (HV) receiving 20 mg citalopram or placebo intravenously, in a randomized cross‐over fashion, underwent two high‐resolution impedance manometry studies involving liquid swallows and a high‐fat, high‐caloric meal. Manometric, reflux, and symptom‐related parameters were studied. Key Results A lower distal contractile integral was recorded under citalopram, compared with placebo (P = 0.026). Upper esophageal sphincter (UES) resting pressure was significantly higher after citalopram administration throughout the study (P < 0.05, all periods). Similarly, the UES postswallow mean and maximum pressures were higher in the citalopram condition (P < 0.0001, in both cases) and this was also the case for the 0.2 s integrated relaxation pressure (P = 0.04). Esophagogastric junction resting pressures in the citalopram visit were significantly higher during swallow protocol, preprandial period, and the first postprandial hour (P < 0.05, in all cases). TLESRs and total reflux events were both reduced after citalopram infusion (P = 0.01, in both cases). During treatment with citalopram, five participants complained about globus sensation (P = 0.06). This citalopram‐induced globus was associated with higher UES postswallow mean and maximum pressure values (P = 0.01 and P = 0.04, respectively). Conclusions and Inferences Administration of citalopram exerts a diversified response on esophageal motility and sphincter function, linked to clinically relevant phenomena: a reduction in postprandial TLESRs and the induction of drug‐induced globus.

The bitter tastant denatonium benzoate has no influence on the number of transient lower esophageal sphincter relaxations in health

“…However, in this study the IGP could not be measured due to disturbing noise at the HRiM measurements in the preprandial period. In the current study, was an adaptation period of 30 min before consumption of the meal, whereas in the study by Manolakis et al, 28 the adaptation period lasted 85 min, leaving us to believe that 30 min is not enough time for the esophagus and proximal stomach to adapt to the HRiM probe leading to noise in the HRiM tracings. Therefore, we cannot assume that the administration of denatonium benzoate has led to a change in IGP profile in this study.…”

Abordaje del paciente con dolor torácico no cardiogénico de origen esofágico

“…También se ha asociado con presiones elevadas del esfínter esofágico superior y sensación de globus, por lo que debe usarse con precaución en pacientes con globus asociado. 146 La teofilina, un antagonista de la adenosina que relaja el músculo liso y tiene propiedades analgésicas viscerales, fue evaluada en dos estudios del grupo de Rao. Los autores demostraron que este fármaco aumentó los umbrales de percepción del dolor en pacientes sometidos a distensión esofágica con balón.…”

The Impact of Medications on Esophageal Motility

“…48 The most recent randomized placebo-controlled cross-over study in 16 healthy volunteers undergoing HRM found citalopram significantly reduced the DCI, increased the upper esophageal resting pressure, increased the integrated relaxation pressure, and reduced TLESRs. 49 Further study is needed to understand the effects on SSRIs on esophageal innervation and motility.…”