<b>Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity</b>

Lancaster-Smith, M.; Prout, B. J.; Pinto, Tais R.C.; Anderson, John A.; Schiff, A. A.

doi:10.1111/j.1600-0447.1982.tb00912.x

Cited by 75 publications

(28 citation statements)

References 9 publications

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“…Identifying an anxiety or affective disorder is not necessary for initiating TCAs since they appear to have an analgesic advantage on somatic pain independent of psychiatric effects. Response to TCAs may in fact be attenuated in the presence of active psychiatric illness [27,28] . Because of their side effects, particular effort must be taken to initiate treatment with TCAs.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

Abdul‐Baki¹,

Hajj²,

El-Zahabi³

et al. 2009

WJG

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AIM:To study the efficacy of low-dose imipramine in relieving symptoms associated with the irritable bowel syndrome (IBS). METHODS:A randomized, double-blind trial of 25 mg imipramine vs matched placebo for 12 wk was performed. Doubling the dose was allowed once at week 2 in case of an unsatisfactory early response. Primary efficacy variables were subjective global symptom relief and quality of life (QoL) using SF-36 at week 12. RESULTS:One hundred and seven patients were enrolled by advertisement or referral by general practitioners and 56 (31 imipramine: 25 placebo) completed the 16-wk study. Baseline characteristics were comparable. A high overall dropout rate was noted in the imipramine and placebo arms (47.5% vs 47.9%, P > 0.05), a mean of 25.0 and 37.4 d from enrollment, respectively (P < 0.05). At the end of 12 wk, there was a significant difference in global symptom relief with imipramine over placebo (per-protocol: 80.6% vs 48.0%, P = 0.01) and a trend on intent-to-treat (ITT) analysis (42.4% vs 25.0%, P = 0.06). This improvement was evident early and persisted to week 16 (P = 0.024 and 0.053 by per-protocol and ITT analyses, respectively). Mean cumulative and componentspecific SF-36 scores improved in the imipramine group only (per-protocol, P < 0.01). Drug-related adverse events leading to patient dropout were more common in the imipramine group (25.4% vs 12.5%, P > 0.05). CONCLUSION:Imipramine may be effective in the treatment of IBS patients and is associated with improved QoL. Careful patient selection, initiation of a low dose with gradual escalation and monitoring for side effects may result in an improved therapeutic response.

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Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

Abdul‐Baki¹,

Hajj²,

El-Zahabi³

et al. 2009

WJG

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“…25 It is likely that these properties are related to the reductions in diarrhoea that have been reported in several clinical trials in patients with IBS, [14][15][16] and also to the ability of these drugs to increase gastrointestinal transit time. 26 Interestingly, it has been shown that administration of amitriptyline or fluoxetine to rats for a period of one month using non-psychiatric doses resulted in enhancement of the sensitivity of contractile intestinal muscle serotonin in vitro.…”

Section: Antidepressantsmentioning

confidence: 99%

“…However, most placebo controlled psychotropic drug trials in IBS indicate that in addition to producing global improvement or beneficial effects on diarrhoea or nausea, tricyclic antidepressants also reduce the severity of abdominal pain. [14][15][16][17] including thermal, mechanical, or electrical stimuli studies indicate that antidepressants reduce pain perception. 18 In placebo controlled studies these drugs reduce pain associated with several somatic pain syndromes, including diabetic neuropathy, post-herpetic neuralgia, tension headaches, and fibromyalgia.…”

Section: Antidepressantsmentioning

confidence: 99%

Centrally acting agents and visceral sensitivity

Fioramonti¹,

Buéno²

2002

Gut

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“…A metaanalysis of randomized controlled trials concluded that the tricyclic antidepressants were superior to placebo in IBS with an number needed to treat (NNT) of 3 [51], although the individual trial results and the quality of the trials has been variable [52][53][54][55][56]. Greenbaum et al for example in a study of desipramine 150 mg daily separated diarrhoea from constipation-predominant IBS, and reported that diarrhoea, abdominal pain and depression but not constipation improved with active drug therapy, compared with atropine or placebo [52].…”

Section: Antidepressants and Anxiolyticsmentioning

confidence: 99%

Evaluation of drug treatment in irritable bowel syndrome

Talley

2003

Brit J Clinical Pharma

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The irritable bowel syndrome (IBS) remains a therapeutic challenge in part because of the limited understanding of the pathophysiology. The placebo response rate varies in randomized controlled trials from 20 to 70%, and can persist for up to at least 1 year. It is contentious whether dietary fibre and bulking agents relieve the symptoms of IBS; constipation probably improves. Anticholinergic and antispasmodic agents are of questionable benefit in IBS despite positive meta-analyses of poor quality trials. A meta-analysis concluded that the tricyclic antidepressants were superior to placebo in IBS, although the individual trial results were variable. Selective serotonin reuptake inhibitors are of uncertain benefit. Laxatives are used for constipation but probably poorly control the IBS symptom complex. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS. Tegaserod is a well-tolerated aminoguanidine indole derivative of serotonin that is a partial 5HT 4 -receptor agonist with prokinetic properties; a therapeutic gain over placebo of 5% to 15% has been observed in constipation-predominant IBS in females. Alosetron is a 5HT 3 -receptor antagonist that is efficacious in females with diarrhoea-predominant IBS, with a 12% to 17% therapeutic gain; the risk of ischaemic colitis is 1 in 350, with very severe constipation occurring in about 1 in 1000. Optimizing study design remains a challenge in IBS. New visceral analgesic and motility modifying agents, as well as anti-inflammatory agents are in trials, and hopefully additional efficacious therapeutic options for patients with IBS will soon emerge.

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Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity

Cited by 75 publications

References 9 publications

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

A randomized controlled trial of imipramine in patients with irritable bowel syndrome

Centrally acting agents and visceral sensitivity

Evaluation of drug treatment in irritable bowel syndrome

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