Effect of Amitriptyline and Escitalopram on Functional Dyspepsia: A Multicenter, Randomized Controlled Study

Area of Science:

• Gastroenterology
• Pharmacology
• Clinical Trials

Background:

• Functional dyspepsia (FD) is a common disorder with upper abdominal symptoms.
• Antidepressants are often prescribed for FD, but evidence of their efficacy is limited.
• This study investigated the effects of antidepressants on FD symptoms, gastric emptying, and satiety.

Purpose of the Study:

• To evaluate the efficacy of amitriptyline and escitalopram in treating functional dyspepsia (FD).
• To assess the impact of these antidepressants on gastric emptying (GE) and meal-induced satiety.
• To determine if antidepressant therapy improves quality of life in FD patients.

Main Methods:

• A randomized, double-blind, placebo-controlled trial involving 292 FD patients without depression.
• Patients received placebo, 50 mg amitriptyline, or 10 mg escitalopram for 10 weeks.
• Primary endpoint: adequate relief of FD symptoms; secondary endpoints: GE time, satiety, and quality of life.

Main Results:

• Amitriptyline showed a trend towards adequate relief (53%) compared to placebo (40%), while escitalopram did not (38%).
• Ulcer-like FD patients on amitriptyline were more likely to achieve adequate relief (OR=3.1).
• Neither drug affected GE or satiety; delayed GE was associated with poorer symptom relief (OR=0.4). Both improved quality of life.

Conclusions:

• Amitriptyline may benefit certain FD patients, particularly those with ulcer-like symptoms.
• Escitalopram did not demonstrate efficacy in this FD patient cohort.
• Patients with delayed gastric emptying do not appear to respond to these antidepressant treatments for FD.