Effects of antidepressants on gastric function in patients with functional dyspepsia

B. E. Lacy, Y. A. Saito, M. Camilleri, E. Bouras, J. K. DiBaise, L. M. Herrick, L. A. Szarka, K. Tilkes, A. R. Zinsmeister, N. J. Talley

Research output: Contribution to journalArticle

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Abstract

Background: Functional dyspepsia (FD) is a highly prevalent functional bowel disorder. The effects of antidepressant therapy (ADTx) on gastric sensorimotor function in FD patients are poorly understood. Aims: Determine whether FD and subtypes with abnormalities in gastric function respond differently to ADTx compared to those with normal physiology. Methods: This multicenter, prospective trial randomized FD patients to 12 weeks of amitriptyline (AMI; 50 mg), escitalopram (ESC; 10 mg), or matching placebo. Demographics, symptoms, psychological distress, gastric emptying, and satiation were measured. Gastric accommodation (GA) using single-photon emission computed tomography imaging was performed in a subset of patients. An intent to treat analysis included all randomized subjects. The effect of treatment on gastric emptying was assessed using ANCOVA. A post hoc appraisal of the data was performed categorizing patients according to the Rome III subgrouping (PDS and EPS). Results: In total, 292 subjects were randomized; mean age=44 yrs. 21% had delayed gastric emptying. Neither antidepressant altered gastric emptying, even in those with baseline delayed gastric emptying. GA increased with ADTx (P=0.02). Neither antidepressant affected the maximal-tolerated volume (MTV) of the nutrient drink test although aggregate symptom scores improved compared to placebo (P=0.04). Patients with the combined EPS-PDS subtype (48%) had a lower MTV on the nutrient drink test compared to the EPS group at baseline (P=0.02). Postprandial bloating improved with both AMI (P=0.03) and ESC (P=0.02). Conclusions: Amitriptyline (50 mg) improves FD symptoms but does not delay gastric emptying, even in patients with baseline delayed gastric emptying. GA improved with low-dose ADTx; the precise mechanism of action is unknown warranting further study.

Original languageEnglish (US)
Pages (from-to)216-224
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume113
Issue number2
DOIs
StatePublished - Feb 1 2018

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Dyspepsia
Gastric Emptying
Antidepressive Agents
Stomach
Amitriptyline
Placebos
Satiation
Food
Citalopram
Single-Photon Emission-Computed Tomography
Multicenter Studies
Demography
Psychology
Therapeutics

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Lacy, B. E., Saito, Y. A., Camilleri, M., Bouras, E., DiBaise, J. K., Herrick, L. M., ... Talley, N. J. (2018). Effects of antidepressants on gastric function in patients with functional dyspepsia. American Journal of Gastroenterology, 113(2), 216-224. https://doi.org/10.1038/ajg.2017.458

Effects of antidepressants on gastric function in patients with functional dyspepsia. / Lacy, B. E.; Saito, Y. A.; Camilleri, M.; Bouras, E.; DiBaise, J. K.; Herrick, L. M.; Szarka, L. A.; Tilkes, K.; Zinsmeister, A. R.; Talley, N. J.

In: American Journal of Gastroenterology, Vol. 113, No. 2, 01.02.2018, p. 216-224.

Research output: Contribution to journalArticle

Lacy, BE, Saito, YA, Camilleri, M, Bouras, E, DiBaise, JK, Herrick, LM, Szarka, LA, Tilkes, K, Zinsmeister, AR & Talley, NJ 2018, 'Effects of antidepressants on gastric function in patients with functional dyspepsia', American Journal of Gastroenterology, vol. 113, no. 2, pp. 216-224. https://doi.org/10.1038/ajg.2017.458
Lacy, B. E. ; Saito, Y. A. ; Camilleri, M. ; Bouras, E. ; DiBaise, J. K. ; Herrick, L. M. ; Szarka, L. A. ; Tilkes, K. ; Zinsmeister, A. R. ; Talley, N. J. / Effects of antidepressants on gastric function in patients with functional dyspepsia. In: American Journal of Gastroenterology. 2018 ; Vol. 113, No. 2. pp. 216-224.
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abstract = "Background: Functional dyspepsia (FD) is a highly prevalent functional bowel disorder. The effects of antidepressant therapy (ADTx) on gastric sensorimotor function in FD patients are poorly understood. Aims: Determine whether FD and subtypes with abnormalities in gastric function respond differently to ADTx compared to those with normal physiology. Methods: This multicenter, prospective trial randomized FD patients to 12 weeks of amitriptyline (AMI; 50 mg), escitalopram (ESC; 10 mg), or matching placebo. Demographics, symptoms, psychological distress, gastric emptying, and satiation were measured. Gastric accommodation (GA) using single-photon emission computed tomography imaging was performed in a subset of patients. An intent to treat analysis included all randomized subjects. The effect of treatment on gastric emptying was assessed using ANCOVA. A post hoc appraisal of the data was performed categorizing patients according to the Rome III subgrouping (PDS and EPS). Results: In total, 292 subjects were randomized; mean age=44 yrs. 21{\%} had delayed gastric emptying. Neither antidepressant altered gastric emptying, even in those with baseline delayed gastric emptying. GA increased with ADTx (P=0.02). Neither antidepressant affected the maximal-tolerated volume (MTV) of the nutrient drink test although aggregate symptom scores improved compared to placebo (P=0.04). Patients with the combined EPS-PDS subtype (48{\%}) had a lower MTV on the nutrient drink test compared to the EPS group at baseline (P=0.02). Postprandial bloating improved with both AMI (P=0.03) and ESC (P=0.02). Conclusions: Amitriptyline (50 mg) improves FD symptoms but does not delay gastric emptying, even in patients with baseline delayed gastric emptying. GA improved with low-dose ADTx; the precise mechanism of action is unknown warranting further study.",
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AU - DiBaise, J. K.

AU - Herrick, L. M.

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