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Antidepressants benefited patients with functional esophageal disorders, GERD
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Antidepressants modulate esophageal sensation and reduce functional chest pain and are beneficial for patients with GERD, according to a recent systematic review.
Aiming to determine the utility of antidepressant therapy for symptoms of esophageal visceral hypersensitivity associated with functional esophageal disorders and GERD, researchers performed a comprehensive search of databases for relevant literature published from 1966 to February 2014. Eligible studies included one abstract, two case reports and 15 randomized, placebo-controlled clinical trials reporting the effects of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors on experimentally induced esophageal sensation and intensity/frequency of heartburn, chest pain, dysphagia or globus.
The reviewed data demonstrated that esophageal pain thresholds increased by 7% to 37% after antidepressant therapy. Furthermore, antidepressants reduced functional chest pain by 18% to 67% and reduced heartburn in patients with GERD by 23% to 61%. No data were available for patients with functional heartburn or functional dysphagia.
“In summary, the results of the trials included in this systematic review provide modest evidence that both TCAs and SSRIs modulate esophageal sensation and reduce functional chest pain,” the researchers wrote. “Limited evidence suggests that SSRIs are beneficial for patients with heartburn, physiological acid exposure, and positive symptom association. Most importantly, this review emphasizes the lack of controlled trials investigating the effect of antidepressants on other esophageal symptomatic disorders.”
Despite its limitations, this study warrants future research on currently available antidepressants, non-antidepressant pain modulators and new esophageal pain modulators, according to an accompanying editorial written by Carla Maradey-Romero, MD, and Ronnie Fass, MD, both from the Esophageal and Swallowing Center and MetroHealth Medical Center at Case Western Reserve University in Cleveland. “Antidepressants are likely to remain the mainstay of treatment of functional esophageal disorders and esophageal disorders with a functional component despite limited evidence from well-designed clinical trials for their efficacy,” they wrote. “Lack of evidence owing to a paucity of clinical trials may not be interpreted as a lack of efficacy of these drugs.”
For more information:
Maradey-Romero C. Clin Gastroenterol Hepatol. 2015;13:260-262.
Weijenborg PW. Clin Gastroenterol Hepatol. 2015;13:251-259.
Disclosure: Some of the researchers report various financial ties with AstraZeneca, Endostim, Given, MMS, Reckitt Benckiser and Shire. Fass and Maradey-Romero report no relevant financial disclosures.