Therapeutic Usefulness of Amitriptyline in Spastic Colon Syndrome

Steinhart, Melvin J.; Wong, Patrick; Zarr, Michael L.

doi:10.2190/wfhg-gr7t-79d6-uqvd

Cited by 56 publications

(31 citation statements)

References 25 publications

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“…Their mechanism in IBS is not completely understood, but has been postulated to relate to an ability to modulate central and peripheral pain perception [110,111] , improve underlying psychiatric conditions, and possibly improve gut motility through modification of neurotransmitter activity [112,113] . Unfortunately, randomized-controlled trials to date have largely been hindered by poor study design and methodological flaws, making it difficult to judge the therapeutic value of these agents [114][115][116] . Most studies provide little evidence that antidepressants are superior to placebo in improving specific IBS-related symptoms, but some do suggest that overall global well-being may be improved.…”

Section: Antidepressantsmentioning

confidence: 99%

Updates on treatment of irritable bowel syndrome

Hammerle¹,

Surawicz²

2008

WJG

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Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain and discomfort in association with altered bowel habits. It is estimated to affect 10%-15% of the Western population, and has a large impact on quality of life and (in)direct healthcare costs. IBS is a multifactorial disorder involving dysregulation within the brain-gut axis, and it is frequently associated with gastrointestinal motor and sensory dysfunction, enteric and central nervous system irregularities, neuroimmune dysregulation, and postinfectious inflammation. As with other functional medical disorders, the treatment for IBS can be challenging. Conventional therapy for those with moderate to severe symptoms is largely unsatisfactory, and the development of new and effective drugs is made difficult by the complex pathogenesis, variety of symptoms, and lack of objective clinical findings that are the hallmark of this disorder. Fortunately, research advances over the past several decades have provided insight into potential mechanisms responsible for the pathogenesis of IBS, and have led to the development of several promising pharmaceutical agents. In recent years there has been much publicity over several of these new IBS medications (alosetron and tegaserod) because of their reported association with ischemic colitis and cardiovascular disease. While these agents remain available for use under restricted prescribing programs, this highlights the need for continued development of safe and effective medication for IBS. This article provides a physiologicallybased overview of recently developed and frequently employed pharmaceutical agents used to treat IBS, and discusses some non-pharmaceutical options that may be beneficial in this disorder.

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Section: Antidepressantsmentioning

confidence: 99%

Updates on treatment of irritable bowel syndrome

Hammerle¹,

Surawicz²

2008

WJG

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“…Most published studies have shown that TCAs improve the symptoms in FGID patients; however, the quality and design of these trials has been variable. [44][45][46][47][48] Of the three recent meta-analyses that have evaluated the possible beneficial effects of TCAs on functional GI symptoms, two concluded that such treatments were beneficial, 49,50 while one concluded that they were not superior to placebo, for the treatment of IBS. 51 Jackson et al 49 were of poor quality and that TCAs were not superior to placebo for global GI symptom improvement.…”

Section: Tricyclic Antidepressantsmentioning

confidence: 99%

Review article: modulation of the brain–gut axis as a therapeutic approach in gastrointestinal disease

Mayer¹,

Tillisch²,

Bradesi³

2006

Aliment Pharmacol Ther

121

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SummaryBackgroundThe importance of bi‐directional brain‐gut interactions in gastrointestinal illness is increasingly being recognized, most prominently in the area of functional gastrointestinal disorders. Numerous current and emerging therapies aimed at normalizing brain–gut interactions are a focus of interest, particularly for irritable bowel syndrome and functional dyspepsia.MethodsA literature search was completed for preclinical and clinical studies related to central modulation of gastrointestinal functions and published in English between 1980 and 2006.ResultsExisting data, while sparse, support the use of different classes of antidepressant drugs, including tricyclics, and selective and non‐selective serotonin reuptake inhibitors in irritable bowel syndrome. Serotonin receptor agonists and antagonists with peripheral and possibly central effects are effective in treating specific subtypes of irritable bowel syndrome. Based largely on theoretical and preclinical evidence, several novel compounds that selectively target receptors at multiple levels within the brain–gut axis such as neurokinin, somatostatin and corticotropin‐releasing factor receptor antagonists are promising.ConclusionsThis review discusses the rationale for modulation of the brain–gut axis in the treatment of functional gastrointestinal disorders and highlights the most promising current and future therapeutic strategies.

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“…Moreover, trials should include baseline assessment of symptoms, account for patient disposition (discontinuations, withdrawals, etc), provide sample size calculation and enroll an adequate number of patients, with the primary outcome being improvement of global IBS symptoms based on patient assessment and/or use of a validated scale to assess IBS symptoms [3] . To date, 10 randomized, controlled trials and two crossover studies have evaluated the effectiveness of TCAs in the treatment of IBS [10][11][12][13][14][15][16][17][18] . The largest and best study to date on TCAs was done by Drossman et al [19] , investigating the role of desipramine in patients with functional disorders.…”

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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Therapeutic Usefulness of Amitriptyline in Spastic Colon Syndrome

Cited by 56 publications

References 25 publications

Updates on treatment of irritable bowel syndrome

Updates on treatment of irritable bowel syndrome

Review article: modulation of the brain–gut axis as a therapeutic approach in gastrointestinal disease

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

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