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Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial
H Roohafza1, Z Pourmoghaddas, H Saneian
1Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Citalopram showed a trend toward effectiveness in treating childhood functional abdominal pain (FAP). Further research with larger patient groups and longer treatment durations is recommended for this pediatric pain condition.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacology
Background:
- Antidepressants are established treatments for adults with functional gastrointestinal disorders.
- Childhood functional abdominal pain (FAP) is a common condition requiring effective therapeutic options.
Purpose of the Study:
- To evaluate the efficacy of citalopram in treating functional abdominal pain in children.
- To assess the impact of citalopram on pain, mood, and somatization symptoms in pediatric patients.
Main Methods:
- A randomized controlled trial involving 115 children (aged 6-18) diagnosed with FAP.
- Participants received either citalopram (20 mg/day) or placebo for 4 weeks, with an 8-week follow-up period.
- Treatment response was defined by a reduction in pain scores or self-reported 'no pain'.
Main Results:
- Per-protocol analysis indicated a trend towards greater pain reduction and global severity improvement with citalopram compared to placebo.
- While not statistically significant in intention-to-treat analysis, per-protocol response rates at week 12 favored citalopram (52.5% vs. 41.0%).
- No significant differences were observed in depression, anxiety, or somatization scores between the groups.
Conclusions:
- Citalopram demonstrates a potential trend for effectiveness in managing childhood functional abdominal pain.
- Larger clinical trials with extended treatment durations are necessary to confirm these findings.
- Further investigation is warranted to establish citalopram's role in pediatric functional abdominal pain management.
Background:
Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP).
Methods:
Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or 'no pain'. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8 weeks after medication period.
Key Results:
Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p = 0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p = 0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F = 3.84, p = 0.024) and global severity scores (F = 4.12, p = 0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study.
Conclusions & Inferences:
Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard.
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