Proton pump inhibitor and selective serotonin reuptake inhibitor therapy for the management of noncardiac chest pain

Viazis, Nikos; Katopodi, Konstantina; Karamanolis, George; Denaxas, Konstantinos; Varytimiadis, Lazaros; Galanopoulos, Michail; Tsoukali, Emmanouela; Kamberoglou, Dimitirs; Christidou, Angeliki; Karamanolis, Dimitrios G.; Papatheodoridis, George V.; Mantzaris, Gerasimos

doi:10.1097/meg.0000000000000925

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…Pharmacological agents designed to address anxiety and depressive symptoms, such as selective serotonin reuptake inhibitors (SSRIs), are also employed by physicians ( 167 ). Viazis and colleagues ( 177 ) trialed the SSRI citalopram alongside proton pump inhibitors in 63 NCCP over a 12-week therapy and found complete resolution of chest pain in 68.5% of patients.…”

Section: Chest Painmentioning

confidence: 99%

Biobehavioral approach to distinguishing panic symptoms from medical illness

Tunnell,

Corner,

Roque

et al. 2024

Front. Psychiatry

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Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.

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Section: Chest Painmentioning

confidence: 99%

Biobehavioral approach to distinguishing panic symptoms from medical illness

Tunnell,

Corner,

Roque

et al. 2024

Front. Psychiatry

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“…Neuromodulators, including tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), are further treatment options for modulating pain threshold and oesophageal sensations. [67][68][69][70][71] It is important to explain clearly to the patient that these medications are being prescribed to modulate the gut-brain axis and not to treat anxiety and depression. They should also be prepared for the fact that it can take up to 6 weeks for the medication to take effect68 and that they may experience some side effects in the first 7-10 days.…”

Section: Gut-brain Behavioural Therapies and Neuromodulatorsmentioning

confidence: 99%

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Hungin

Scarpignato

Keefer

et al. 2022

Aliment Pharmacol Ther

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Summary Background Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux‐like symptoms, persistent symptoms are commonly reported in primary care and community studies. Aims This multidisciplinary review critically evaluates how the management of reflux‐like symptoms could better reflect their multifactorial pathophysiology. Methods A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care. Results It was agreed that the perceptual (as well as the physiological) causes of reflux‐like symptoms should be considered at the start of management, not as a last resort when all else has failed. A short course of PPI is a pragmatic approach to address reflux‐like symptoms, but equally important is counselling about the gut‐brain axis and provision of symptom‐specific behavioural interventions for those who show signs of somatisation, hypervigilance or co‐existing disorders of gut‐brain interaction. Other low‐harm interventions such as lifestyle and dietary advice, should also be better integrated into care at an early stage. Multidisciplinary care management programmes (including dietary, weight loss, exercise and behavioural intervention) should be developed to promote greater self‐management and take advantage of the general shift toward the use of remotely accessed health care resources. Conclusions Management of reflux‐like symptoms should be adapted to reflect the advances in knowledge about the multifactorial aetiology of these symptoms, addressing both acid‐related and behavioural components early in management. The time has come to treat the patient, not the “disease”.

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“…Citalopram (Celexa™, Cipramil™) is administered in 10-80 mg dose once daily for the treatment of depression ( Table 3). It has been investigated for the treatment of fibromyalgia and chronic tension-type headache, with no beneficial results [47][48][49], while for somatoform pain disorders it has only moderate analgesic effect [50][51][52].…”

Section: Citaloprammentioning

confidence: 99%

Serotonin Reuptake Inhibitors and Their Role in Chronic Pain Management

Onuţu¹,

Dîrzu²,

Petrișor³

2019

Serotonin

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Serotonin has a particular place in the modulation of pain. Experimental studies have described 5-HT1-7 receptors and their effects on facilitation or inhibition of nociceptive input. Selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors showed efficient and safer than tricyclic antidepressants in neuropathic pain. Although there is evidence regarding the beneficial impact of SSRIs in the multimodal acute pain management, studies are still searching for the potentially favorable effect of these drugs in the prevention of chronic postoperative pain. The scope of this chapter would be to update the knowledge regarding serotonin involving in pain pathways and to highlight the importance and contribution of serotonin reuptake inhibitors in the multimodal pain management schemes.

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Proton pump inhibitor and selective serotonin reuptake inhibitor therapy for the management of noncardiac chest pain

Abstract: Combined impedance-pH monitoring identifies different subtypes of NCCP patients who can receive tailored management. Targeted therapy with PPIs and/or citalopram offers complete symptom relief in the great majority of them.

Cited by 5 publications

References 35 publications

Biobehavioral approach to distinguishing panic symptoms from medical illness

Biobehavioral approach to distinguishing panic symptoms from medical illness

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Serotonin Reuptake Inhibitors and Their Role in Chronic Pain Management

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