Low-dose imipramine for refractory functional dyspepsia: a randomised, double-blind, placebo-controlled trial

Cheong, Pui Kuan; Ford, Alexander C; Cheung, CL; Ching, Jessica; Chan, Yawen; Sung, Joseph J.Y.; Chan, Francis K.L.; Wu, Justin Che Yuen

doi:10.1016/s2468-1253(18)30303-0

Cited by 36 publications

(43 citation statements)

References 43 publications

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“…Two RCTs from Asia compared TCAs with placebo for patients with refractory FD. 131,132 The first study found imipramine to be effective in relief of dyspeptic symptoms after 12 weeks of administration, compared with placebo. 131 However, the other study reported that nortriptyline failed to achieve reduction in dyspeptic symptoms after 8 weeks of treatment.…”

Section: Fundic Relaxantsmentioning

confidence: 99%

“…131,132 The first study found imipramine to be effective in relief of dyspeptic symptoms after 12 weeks of administration, compared with placebo. 131 However, the other study reported that nortriptyline failed to achieve reduction in dyspeptic symptoms after 8 weeks of treatment. 132 There was a research showing that TCAs were more effective in treating ulcer-like FD, corresponding to the EPS type, than in dysmotility-like FD.…”

Section: Fundic Relaxantsmentioning

confidence: 99%

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Clinical Practice Guidelines for Functional Dyspepsia in Korea

Kwon

Jung

et al. 2020

J Neurogastroenterol Motil

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Functional dyspepsia (FD) is a chronic upper gastrointestinal (GI) symptom complex that routine diagnostic work-up, such as endoscopy, blood laboratory analysis, or radiological examination, fails to identify a cause. It is highly prevalent in the World population, and its response to the various available therapeutic strategies is only modest because of the heterogenous nature of its pathogenesis. Therefore, FD represents a heavy medical burden for healthcare systems. We constituted a guideline development committee to review the existing guidelines on the management of functional dyspepsia. This committee drafted statements and conducted a systematic review and meta-analysis of various studies, guidelines, and randomized control trials. External review was also conducted by selected experts. These clinical practice guidelines for FD were developed based on evidence recently accumulated with the revised version of FD guidelines released in 2011 by the Korean Society of Neurogastroenterology and Motility. These guidelines apply to adults with chronic symptoms of FD and include the diagnostic role of endoscopy, Helicobacter pylori screening, and systematic review and meta-analyses of the various treatment options for FD (proton pump inhibitors, H. pylori eradication, and tricyclic antidepressants), especially according to the FD subtype. The purpose of these new guidelines is to aid the understanding, diagnosis, and treatment of FD, and the targets of the guidelines are clinicians, healthcare workers at the forefront of patient care, patients, and medical students. The guidelines will continue to be revised and updated periodically. (J Neurogastroenterol Motil 2020;26:29-50)

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Section: Fundic Relaxantsmentioning

confidence: 99%

Section: Fundic Relaxantsmentioning

confidence: 99%

Clinical Practice Guidelines for Functional Dyspepsia in Korea

Kwon

Jung

et al. 2020

J Neurogastroenterol Motil

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“…23 These bidirectional brain-gut pathways have been described previously in people with functional GI disorders, 24,25 and centrally acting treatments in functional GI disorders can improve symptoms and quality of life. [26][27][28][29] Whether targeting these potential mechanisms will improve both psychological wellbeing and disease outcomes in IBD is less certain. To date, clinical trials of therapies targeting psychological disorders in IBD have shown limited benefit, 30,31 but the number of studies examining this issue is small, and limitations in their design impacts the findings.…”

Section: Introductionmentioning

confidence: 99%

The influence of the brain–gut axis in inflammatory bowel disease and possible implications for treatment

Gracie

Hamlin

Ford

2019

The Lancet Gastroenterology & Hepatology

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199

133

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“…The search strategy generated 11 425 citations, 83 of which we retrieved for further assessment as they appeared to be relevant (Figure S2). Of these, 67 articles were eligible for inclusion, 31‐97 which reported on 71 separate RCTs comprising 19 243 participants. Of these, 12 535 received a drug for FD and 6708 a placebo, allocated as described in Table S2.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and network meta‐analysis: efficacy of drugs for functional dyspepsia

Ford

Martin

Black

et al. 2020

Aliment Pharmacol Ther

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Summary Background Functional dyspepsia (FD) is a relapsing and remitting condition affecting between 5% and 10% of people. Efficacious therapies are available, but their relative efficacy is unknown. Aim To perform a systematic review with network meta‐analysis to resolve this uncertainty. Methods We searched the medical literature through July 2020 for randomised controlled trials (RCTs) assessing efficacy of drugs for adults with FD, compared with each other, or placebo. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic with a 95% confidence interval (CI) to summarise efficacy of each comparison tested. Relative ranking was assessed with surface under the cumulative ranking curve (SUCRA) probabilities. Results We identified 71 eligible RCTs (19 243 participants). Tricyclic antidepressants (TCAs) were ranked second for efficacy (RR of remaining symptomatic = 0.71; 95% CI 0.58‐0.87, SUCRA 0.87), and first when only low risk of bias trials were included. Most RCTs that used TCAs recruited patients who were refractory to other drugs included in the network. Although sulpiride or levosulpiride were ranked first for efficacy (RR = 0.49; 95% CI 0.36‐0.69, SUCRA 0.99), trial quality was low and only 86 patients received active therapy. TCAs were more likely to cause adverse events than placebo. Conclusions TCAs, histamine‐2 receptor antagonists, standard‐ and low‐dose proton pump inhibitors, sulpiride or levosulpiride, itopride and acotiamide were all more efficacious than placebo for FD.

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Low-dose imipramine for refractory functional dyspepsia: a randomised, double-blind, placebo-controlled trial

Cited by 36 publications

References 43 publications

Clinical Practice Guidelines for Functional Dyspepsia in Korea

Clinical Practice Guidelines for Functional Dyspepsia in Korea

The influence of the brain–gut axis in inflammatory bowel disease and possible implications for treatment

Systematic review and network meta‐analysis: efficacy of drugs for functional dyspepsia

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