Patients with a hypersensitive esophagus may get relief of gastroesophageal reflux disease (GERD) from selective serotonin reuptake inhibitors (SSRIs), researchers said here.
After six months on citalopram (Celexa), only 23% of patients who'd had acid reflux problems reported continued symptoms, compared with 67% of those on placebo, Nikos Viazis, MD, of Evangelismos Hospital in Athens, Greece, and colleagues, reported during an oral session at Digestive Disease Week.
"In some patients, proton pump inhibitors (PPIs) fail, but we don't know the causes of treatment failure," Viazis said. "Maybe [acid] isn't the cause."
Rather, patients may have a hypersensitive esophagus, he said. In patients who are refractory to PPIs, researchers can use pH-impedance monitoring to assess whether a relationship exists between symptoms and reflux episodes.
Viazis and colleagues wanted to distinguish patients with hypersensitive esophagus and evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) on their symptoms.
They selected 84 patients who had typical reflux symptoms despite a PPI twice daily, and set them up for 24-hour pH-impedance monitoring. Their mean age was 55 years.
Of those patients, 73 reported symptoms during the day, and 35 of those had a positive symptom index with acid. Among those 35 patients, 25 had normal distal esophageal acid exposure time, indicative of a hypersensitive esophagus, and were randomized to receive 20 mg of citalopram or placebo once a day for six months.
The researchers found that at the end of the study, only 23% of those on citalopram still had reflux symptoms, compared with 67% of those on placebo, which was significantly different (P=0.047).
"The results show that treatment with SSRI is effective for patients with hypersensitive esophagus," Viazis said.
The researchers said they did not have an explanation for the findings, other than a previous study which had shown that patients taking an SSRI had a higher threshold for esophageal pain.
Viazis said that there were no major side effects, as none were reported during monthly patient visits. Some had slight nausea or dizziness in the first week or two of taking the drug, but none had to discontinue it.
"No one felt it was interfering with their daily activities or daily life," he said.
Viazis added that patients with a negative symptom index may benefit from treatment with SSRI as well, but that needs to be looked at in further studies.
The researchers reported no conflicts of interest.
Source: MedPage Today, May 6, 2010
Source reference: Viazis N, et al "Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: A placebo-controlled study using esophageal pH-impedance monitoring" DDW 2010: Abstract 934.
By Mortin - Copyright 2010
Last modification 19/05/2010