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Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain

BACKGROUND: Functional chest pain (FCP) is characterized by the presence of chest pain of presumed esophageal origin, but with a negative workup on routine investigations, including ruling out gastroesophageal reflux disease (GERD). Antidepressants are frequently prescribed to treat FCP and are pres...

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Autores principales: Voulgaris, Theodoros, Lekakis, Vassileios, Vlachogiannakos, Jiannis, Kamberoglou, Dimitrios, Orfanidou, Afroditi, Papatheodoridis, George, Karamanolis, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hellenic Society of Gastroenterology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756034/
https://www.ncbi.nlm.nih.gov/pubmed/36593804
http://dx.doi.org/10.20524/aog.2023.0759
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author Voulgaris, Theodoros
Lekakis, Vassileios
Vlachogiannakos, Jiannis
Kamberoglou, Dimitrios
Orfanidou, Afroditi
Papatheodoridis, George
Karamanolis, George
author_facet Voulgaris, Theodoros
Lekakis, Vassileios
Vlachogiannakos, Jiannis
Kamberoglou, Dimitrios
Orfanidou, Afroditi
Papatheodoridis, George
Karamanolis, George
author_sort Voulgaris, Theodoros
collection PubMed
description BACKGROUND: Functional chest pain (FCP) is characterized by the presence of chest pain of presumed esophageal origin, but with a negative workup on routine investigations, including ruling out gastroesophageal reflux disease (GERD). Antidepressants are frequently prescribed to treat FCP and are presumed to act as neuromodulators of visceral hypersensitivity. However, there is little evidence of their efficacy in patients with FCP. We retrospectively assessed the efficacy of citalopram or amitriptyline vs. no treatment in patients with FCP. METHODS: Esophageal diseases, including GERD, eosinophilic esophagitis and major esophageal motility disorders, were excluded. Thus, patients with established FCP according to Rome IV criteria were included in the study. Then, patients treated for at least 3 months with citalopram 20 mg, amitriptyline 50 mg, or observation were selected. The primary endpoint was complete disappearance or significant amelioration of symptoms at the end of treatment. RESULTS: Over a 5-year period, 102 patients (74 female; mean age 49±10 years) were diagnosed with FCP and were recognized to have received once daily citalopram (n=32), amitriptyline (n=34), or no treatment (n=36). After a 3-month follow up, improvement in chest pain was reported by 16 (47.1%) patients treated with citalopram, 18 (56.3%) patients treated with amitriptyline, and 4 (11.1%) patients without treatment (P=0.02 and 0.01 for no treatment vs. citalopram and amitriptyline therapy, respectively). CONCLUSION: Both citalopram and amitriptyline are effective pharmacological options in the symptomatic relief of almost 50% patients with well characterized FCP.
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spelling pubmed-97560342023-01-01 Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain Voulgaris, Theodoros Lekakis, Vassileios Vlachogiannakos, Jiannis Kamberoglou, Dimitrios Orfanidou, Afroditi Papatheodoridis, George Karamanolis, George Ann Gastroenterol Original Article BACKGROUND: Functional chest pain (FCP) is characterized by the presence of chest pain of presumed esophageal origin, but with a negative workup on routine investigations, including ruling out gastroesophageal reflux disease (GERD). Antidepressants are frequently prescribed to treat FCP and are presumed to act as neuromodulators of visceral hypersensitivity. However, there is little evidence of their efficacy in patients with FCP. We retrospectively assessed the efficacy of citalopram or amitriptyline vs. no treatment in patients with FCP. METHODS: Esophageal diseases, including GERD, eosinophilic esophagitis and major esophageal motility disorders, were excluded. Thus, patients with established FCP according to Rome IV criteria were included in the study. Then, patients treated for at least 3 months with citalopram 20 mg, amitriptyline 50 mg, or observation were selected. The primary endpoint was complete disappearance or significant amelioration of symptoms at the end of treatment. RESULTS: Over a 5-year period, 102 patients (74 female; mean age 49±10 years) were diagnosed with FCP and were recognized to have received once daily citalopram (n=32), amitriptyline (n=34), or no treatment (n=36). After a 3-month follow up, improvement in chest pain was reported by 16 (47.1%) patients treated with citalopram, 18 (56.3%) patients treated with amitriptyline, and 4 (11.1%) patients without treatment (P=0.02 and 0.01 for no treatment vs. citalopram and amitriptyline therapy, respectively). CONCLUSION: Both citalopram and amitriptyline are effective pharmacological options in the symptomatic relief of almost 50% patients with well characterized FCP. Hellenic Society of Gastroenterology 2023 2022-11-15 /pmc/articles/PMC9756034/ /pubmed/36593804 http://dx.doi.org/10.20524/aog.2023.0759 Text en Copyright: © Hellenic Society of Gastroenterology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Voulgaris, Theodoros
Lekakis, Vassileios
Vlachogiannakos, Jiannis
Kamberoglou, Dimitrios
Orfanidou, Afroditi
Papatheodoridis, George
Karamanolis, George
Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title_full Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title_fullStr Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title_full_unstemmed Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title_short Efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
title_sort efficacy of citalopram or amitriptyline versus no treatment in patients with functional chest pain
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9756034/
https://www.ncbi.nlm.nih.gov/pubmed/36593804
http://dx.doi.org/10.20524/aog.2023.0759
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