Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis11The opinions in this article represent those of the authors and are not to be construed, in any way, to represent those of the U.S. Army or the Department of Defense.

Jackson, Jeffrey L.; O’Malley, Patrick G.; Tomkins, Glen; Balden, Erin; Santoro, James; Kroenke, Kurt

doi:10.1016/s0002-9343(99)00299-5

Cited by 412 publications

(35 citation statements)

References 62 publications

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“…The justification for treatment of functional gastrointestinal disorders with antidepressant medications is that: (1) antidepressants could reduce the severity of psychological symptoms, particularly anxiety and depression, which are thought to exacerbate the symptoms of dyspepsia and may in some cases be etiologically linked to the syndrome; (2) antidepressants may have central analgesic actions and could modulate afferent sensory signals from the gastrointestinal tract, and (3) some antidepressants may have local pharmacological actions on the upper gut, altering transit and gastric accommodation [2,3,4,5,6]. Therefore, identifying which antidepressants improve symptoms and the mechanisms that lead to this improvement may result in better targeted therapy of functional dyspepsia.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis by Jackson et al [3] of 12 randomized trials concluded that treatment of functional gastrointestinal disorders with tricyclic antidepressants appears to be effective, but many of the studies were of low quality and only one small crossover study evaluated patients with functional dyspepsia [4]. In a large well-conducted randomized controlled trial, Drossman et al [5] observed that low dose desipramine was superior to placebo in functional bowel disease on the per protocol analysis although it was not in the intention-to-treat analysis because of dropouts.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Desipramine and Escitalopram on Postprandial Symptoms Induced by the Nutrient Drink Test in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study

et al. 2005

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Background: Antidepressants are widely used to treat functional gastrointestinal disorders but their effect on postprandial symptoms remains unstudied. We hypothesized that desipramine and escitalopram would enhance the maximum tolerated volume of nutrient ingested and decrease postprandial symptoms. Methods: Healthy participants (n = 45) all underwent an assessment of symptoms, anxiety and depression, and a standard nutrient drink test (Ensure). Participants were randomized to 11 days of desipramine (50 mg once daily), escitalopram (10 mg once daily) or identical placebo. Results: The maximum tolerated gastric volumes were not significantly different on day 11 for desipramine (1,136 ± 478 ml, mean ± SD), escitalopram (1,198 ± 422 ml) and placebo (1,231 ± 318 ml). A univariate analysis indicated significant treatment group effects on total symptom scores (p = 0.049), but after adjusting for age, gender, BMI and baseline scores, treatment effects were no longer significant (p = 0.15). Conclusions: While this study does not rule out a beneficial effect of tricyclics or selective serotonin reuptake inhibitors in functional dyspepsia, neither desipramine nor escitalopram significantly altered the nutrient volume ingested or symptoms induced by the nutrient drink test in healthy volunteers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Desipramine and Escitalopram on Postprandial Symptoms Induced by the Nutrient Drink Test in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study

et al. 2005

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“…Centrally acting antidepressants such as amitriptyline and desipramine have been found to be effective in patients with functional gastrointestinal disorders in general [52], but no studies have proven these medications to be effective in patients with GBD in particular. The antibiotic and motilin agonist erythromycin induces gallbladder contraction and reduces fasting and postprandial gallbladder volumes [53,54].…”

Section: Treatmentmentioning

confidence: 99%

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

Goussous¹,

Kowdley²,

Sardana³

et al. 2014

Digestion

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Background: Motility disorders of the biliary tree [biliary dyskinesia, including both gallbladder dysfunction (GBD), and sphincter of Oddi dysfunction] are difficult to diagnose and to treat. Summary: There is controversy in the literature in particular regarding the criteria that should be used to select patients for cholecystectomy (CCY) in cases of suspected GBD. The current review covers the history, diagnosis, and treatment of GBD. Key Messages: Only >85% of patients with suspected GBD have relief following CCY, a much lower rate than the nearly 100% success rate following CCY for gallstone disease. Unfortunately, the literature is lacking, and there are no universally agreed-upon criteria for selecting which patients to refer for operation, although cholecystokinin (CCK)-enhanced hepatobiliary iminodiacetic acid scan is often used, with emphasis on an abnormally low gallbladder ejection fraction or pain reproduction at CCK administration. There is a clear need for large, well-designed, more definitive, prospective studies to better identify the indications for and efficacy of CCY in cases of GBD. i 2014 S. Karger AG, Basel

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“…A large community survey in eight European countries has shown an overall prevalence of 11.5% 3 and the disease is one of the more common reasons for visiting general practitioners or gastroenterologists 1,4. In addition, IBS has a well-demonstrated negative impact on quality of life (QoL) and is associated with a significant burden related to both direct and indirect (inability to work) costs 5.…”

Section: Introductionmentioning

confidence: 99%

On‐demand treatment with alverine citrate/simeticone compared with standard treatments for irritable bowel syndrome: results of a randomised pragmatic study

Ducrotté

Grimaud

Dapoigny³

et al. 2013

Int J Clin Pract

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BackgroundIn routine practice, irritable bowel syndrome (IBS) symptoms are often difficult to be relieved and impair significantly patients’ quality of life (QoL). A randomised, double-blind, placebo-controlled study has shown the efficacy of alverine citrate/simeticone (ACS) combination for IBS symptom relief.AimAs IBS symptoms are often intermittent, this pragmatic study was designed to compare the efficacy of an on-demand ACS treatment vs. that of usual treatments.MethodsRome III IBS patients were enrolled by 87 general practitioners who were randomly allocated to one of two therapeutic strategies: on-demand ACS or usual treatment chosen by the physician. The primary outcome measure was the improvement of the IBSQoL score between inclusion and month 6.ResultsA total of 436 patients (mean age: 54.4 years; women: 73.4%) were included, 222 in the ACS arm and 214 patients in the usual treatment arm, which was mainly antispasmodics. At 6 months, improvement of IBSQoL was greater with ACS than with the usual treatment group (13.8 vs. 8.4; p < 0.0008). The IBS-severity symptom score (IBS-SSS) was lower with ACS than in the usual treatment arm with a mean (SE) decrease of 170.0 (6.6) vs. 110.7 (6.7), respectively (p = 0.0001). An IBS-SSS < 75 was more frequent in the ACS group (37.7% vs. 16.0%; p < 0.0001). Improvement of both abdominal pain and bloating severity was also greater with the on-demand ACS treatment, which was associated with both lower direct and indirect costs.ConclusionsAfter 6 months, on-demand ACS treatment led to a greater improvement of QoL, reduced the burden of the disease and was more effective for IBS symptom relief than usual treatments.

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Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis11The opinions in this article represent those of the authors and are not to be construed, in any way, to represent those of the U.S. Army or the Department of Defense.

Cited by 412 publications

References 62 publications

Effects of Desipramine and Escitalopram on Postprandial Symptoms Induced by the Nutrient Drink Test in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study

Effects of Desipramine and Escitalopram on Postprandial Symptoms Induced by the Nutrient Drink Test in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study

Gallbladder Dysfunction: How Much Longer Will It Be Controversial?

On‐demand treatment with alverine citrate/simeticone compared with standard treatments for irritable bowel syndrome: results of a randomised pragmatic study

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