Efficacy of psychotropic drugs in functional dyspepsia: systematic review and meta-analysis

Abstract

Abbreviations:5 However, benefit was limited to antipsychotics and tricyclic antidepressants. When only studies that excluded individuals with co-existent mood disorder were considered, there was no benefit. Total numbers of adverse events and adverse events leading to withdrawal were significantly more common, with a number needed to harm of 21 for both. Conclusion:Psychotropic drugs may be an effective treatment for FD, but the effect appears to be limited to antipsychotics and tricyclic antidepressants with fewer trials for other agents, meaning that firm conclusions for efficacy cannot be made. More data from high quality RCTs are required to support their use in the treatment of FD.Ford et al. of 48What is already known about this subject?Functional dyspepsia (FD) is common and difficult to treat.Helicobacter pylori eradication therapy and proton pump inhibitors are efficacious treatments for FD, but the benefits are modest.Estimates of the efficacy of psychotropic drugs in FD have been hampered by a paucity of randomised controlled trials (RCTs), and a failure to report extractable dichotomous data. What are the new findings?We identified 13 RCTs, and successfully contacted original investigators to obtain supplementary dichotomous data.Psychotropic drugs were more effective than placebo for the treatment of FD, with a number needed to treat of 6 (95% confidence interval (CI) 4 to 16).However, this beneficial effect was limited to antipsychotic drugs, such as sulpiride and levosulpiride, and tricyclic antidepressants (TCADs), such as amitriptyline and imipramine.Adverse events were more common (number needed to harm 21 (95% CI 9 to 597)).How might it impact on clinical practice in the near future?

ACG and CAG Clinical Guideline: Management of Dyspepsia

“…Th ere were two trials ( 128,129 ) involving 388 FD patients comparing SSRIs with placebo. Th ere was no statistically signifi cant eff ect of SSRI therapy on dyspepsia symptoms (RR=1.01; 95% CI=0.89-1.15) ( 72 ).…”

Functional dyspepsia

“…New data support the role of low-dose tricyclic antidepressants in functional dyspepsia, although the mechanism of action is unclear 200 . Although a role of the gut microbiota in functional dyspepsia is emerging, clinical studies to test this concept with therapeutics such as well-defined and specific probiotics have yet to be performed.…”

“…Centrally acting neuro modulators are overall superior to placebo in improving functional dyspepsia, and this effect could occur in the absence of major depressive or anxiety comorbidity 200 . However, the benefit was limited to antipsychotics (D(2) dopamine receptor antagonists) and tricyclic antidepressants (which are particularly effective in EPS 201 ).…”

Functional Dyspepsia: Advances in Diagnosis and Therapy

“…The tricyclic was efficacious for those with epigastric pain but was not of benefit in those with delayed gastric emptying 95. A meta-analysis of psychotropic agents concluded tricyclic antidepressants were superior to placebo but there remains a risk of side effects with this class of agents with the number needed to harm being seven 96. There was no benefit observed over placebo with the SSRIs or selective norepinephrine reuptake inhibitors 96.…”