Efficacy of Mirtazapine in Patients With Functional Dyspepsia and Weight Loss

Tack, Jan; Ly, Huynh Giao; Carbone, Florencia; Vanheel, Hanne; Vanuytsel, Tim; Holvoet, Lieselot; Boeckxstaens, Guy E.; Caenepeel, Philip; Arts, Joris; Oudenhove, Lukas Van

doi:10.1016/j.cgh.2015.09.043

Cited by 148 publications

(103 citation statements)

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“…However, through their effects on gastrointestinal motility, they could also exert therapeutic effects in PDS, as described for 5-HT1A agonists that act on gastric accommodation. The antidepressant mirtazapine, when taken at a low dose in the evening, has also shown efficacy for the treatment of early satiety and nausea in patients with functional dyspepsia with weight loss who had no clinically relevant depression or anxiety comorbidity 197 .…”

Section: Pharmacological Treatment Of Pdsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Section: Pharmacological Treatment Of Pdsmentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

Self Cite

260

247

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“…Current treatment options for FD are limited, as developing treatments has been challenging due to the heterogeneous nature of the condition, especially for complicated disorders between central and peripheral functions. Therefore, the efficacies of acid suppressants, prokinetics, and anxiolytics have remained low, because these drugs address only part of this diverse pathophysiology . Together with these findings, characteristic drugs acting for both directions (the gut‐brain axis) may be required to treat FD.…”

Section: Introductionmentioning

confidence: 99%

Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: A randomized clinical trial (the DREAM study)

Tominaga

Sakata²,

Kusunoki

et al. 2018

Neurogastroenterology Motil

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“…Of particular interest in relation to gastroparesis, symptom control is mirtazapine’s agonism of central and peripheral 5-HT1A serotonin receptors. This receptor is known to contribute to gastric receptive fundic relaxation, and its stimulation by mirtazapine has been shown in multiple double-blinded, randomized, placebo-controlled trials to improve symptom control, weight loss, early satiation, and overall quality of life in patients with functional dyspepsia 4–7. It has been recognized as an effective antiemetic in several settings: palliative care, chemotherapy patients, postsurgery patients, and even idiopathic nausea and vomiting 8–13.…”

Section: Introductionmentioning

confidence: 99%

“…It has been recognized as an effective antiemetic in several settings: palliative care, chemotherapy patients, postsurgery patients, and even idiopathic nausea and vomiting 8–13. Most notably, Tack et al have found in multiple randomized placebo-controlled trials that mirtazapine is effective for nausea and other symptoms in functional dyspepsia, a condition with similar symptomatology to gastroparesis 5,7. However, there are only a handful of case reports on the effect of mirtazapine in gastroparesis.…”

Section: Introductionmentioning

confidence: 99%

Mirtazapine for symptom control in refractory gastroparesis

Malamood¹,

Roberts

Kataria

et al. 2017

DDDT

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IntroductionGastroparesis symptoms can be severe and debilitating. Many patients do not respond to currently available treatments. Mirtazapine has been shown in case reports to reduce symptoms in gastroparesis.AimTo assess the efficacy and safety of mirtazapine in gastroparetic patients.MethodsAdults with gastroparesis and poorly controlled symptoms were eligible. Participants were prescribed mirtazapine 15 mg PO qhs. Questionnaires containing the gastrointestinal cardinal symptom index (GCSI) and the clinical patient grading assessment scale (CPGAS) were completed by patients’ pretreatment, at 2 weeks, and at 4 weeks. Primary end point was nausea and vomiting response to mirtazapine using the GCSI. Secondary end point was nausea and vomiting severity assessment using the CPGAS. P-values were calculated using the paired two-tailed Student’s t-test. Intention to treat analysis was used.ResultsA total of 30 patients aged 19–86 years were enrolled. Of those, 24 patients (80%) completed 4 weeks of therapy. There were statistically significant improvements in nausea, vomiting, retching, and perceived loss of appetite at 2 and 4 weeks (all P-values <0.05) compared with pretreatment. There was a statistically significant improvement in the CPGAS score at week 2 (P=0.003) and week 4 (P<0.001). Of the total patients, 14 (46.7%) experienced adverse effects from mirtazapine and due to this, 6 patients stopped therapy.ConclusionMirtazapine significantly improved both nausea and vomiting in gastroparetics after 2 and 4 weeks of treatment. Side effects led to treatment self-cessation in a fifth of patients. From these data, we conclude that mirtazapine improves nausea and vomiting, among other symptoms, in patients with gastroparesis and might be useful in select patients.

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Efficacy of Mirtazapine in Patients With Functional Dyspepsia and Weight Loss

Abstract: In a randomized, placebo-controlled trial, mirtazapine significantly improved early satiation, quality of life, gastrointestinal-specific anxiety, nutrient tolerance, and weight loss in patients with FD. ClinicalTrials.gov number: NCT01240096.

Cited by 148 publications

References 38 publications

Functional dyspepsia

Functional dyspepsia

Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: A randomized clinical trial (the DREAM study)

Mirtazapine for symptom control in refractory gastroparesis

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