Amitriptyline for the Treatment of Extra-esophageal Symptoms in Proton Pump Inhibitor-refractory Patients With Suspected Gastroesophageal Reflux Disease.

IF 3.3 3区 医学 Q2 CLINICAL NEUROLOGY
Jieun Woo, Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
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引用次数: 0

Abstract

Background/aims: Gastroesophageal reflux disease (GERD) is a chronic, heterogeneous condition that impairs quality of life. Extraesophageal symptoms (eg, globus sensation, chronic cough, hoarseness, wheezing) often persist despite proton pump inhibitor (PPI) therapy. Tricyclic antidepressants are recommended for such refractory cases, but supporting evidence is limited. This study aimed to evaluate the efficacy of low-dose amitriptyline in treating extraesophageal GERD symptoms.

Methods: We conducted a single-center, single-blind, randomized, controlled crossover pilot trial (2016-2021). Forty patients with typical GERD symptoms plus ≥ 1 atypical symptom (eg, globus, cough) unresponsive to ≥ 4 weeks of PPI therapy were randomized to receive either lansoprazole 30 mg daily plus amitriptyline 10 mg at bedtime or lansoprazole alone for 4 weeks, followed by crossover to the alternate regimen. The primary outcome was symptom improvement assessed by numeric rating scale. Secondary outcomes included changes in quality of life (QoL) measured by the 36-item Short Form survey.

Results: All 40 patients completed the trial. Overall, 75% reported symptom improvement: 65% in the amitriptyline group vs. 85% in the PPI group (P = 0.27). Both groups showed significant reductions in symptom severity (between-group P = 0.90) and improvements in QoL (physical and mental summary scores; P = 0.60 and 0.41, respectively). These improvements persisted post-crossover.

Conclusions: Adding low-dose amitriptyline to PPI therapy did not offer a short-term advantage over PPI alone. Both treatments improved symptoms and QoL. Given the challenging nature of GERD's extraesophageal manifestations and mixed evidence for neuromodulator therapy, further studies are needed to identify patient subgroups that may benefit from adjunctive neuromodulator therapy.

阿米替林治疗质子泵抑制剂难治性疑似胃食管反流病患者的食管外症状
背景/目的:胃食管反流病(GERD)是一种慢性、异质性的损害生活质量的疾病。尽管质子泵抑制剂(PPI)治疗,食管外症状(如球感、慢性咳嗽、声音嘶哑、喘息)经常持续存在。三环类抗抑郁药推荐用于此类难治性病例,但支持证据有限。本研究旨在评价小剂量阿米替林治疗食管外反流症状的疗效。方法:我们进行了一项单中心、单盲、随机、对照的交叉试验(2016-2021)。40例典型胃食管反流症状加≥1种非典型症状(如肾小球、咳嗽)对PPI治疗无反应≥4周的患者被随机分为每日30 mg兰索拉唑加睡前10 mg阿米替林或单独使用兰索拉唑4周,然后交叉到替代方案。主要结局是用数值评定量表评估症状改善。次要结果包括生活质量(QoL)的变化,通过36项简短形式调查测量。结果:40例患者全部完成试验。总的来说,75%的患者报告症状改善:阿米替林组65% vs PPI组85% (P = 0.27)。两组症状严重程度均显著降低(组间P = 0.90),生活质量显著改善(身心综合评分;P分别= 0.60和0.41)。这些改进在跨界后持续存在。结论:在PPI治疗中加入低剂量阿米替林并不比单独使用PPI具有短期优势。两种治疗方法均改善了症状和生活质量。考虑到胃食管反流的食管外表现具有挑战性,以及神经调节剂治疗的证据不一,需要进一步的研究来确定可能受益于辅助神经调节剂治疗的患者亚组。
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来源期刊
Journal of Neurogastroenterology and Motility
Journal of Neurogastroenterology and Motility GASTROENTEROLOGY & HEPATOLOGY-CLINICAL NEUROLOGY
CiteScore
6.30
自引率
8.80%
发文量
96
期刊介绍: Journal of Neurogastroenterology and Motility (J Neurogastroenterol Motil) is a joint official journal of the Korean Society of Neurogastroenterology and Motility, the Thai Neurogastroenterology and Motility Society, the Japanese Society of Neurogastroenterology and Motility, the Indian Motility and Functional Disease Association, the Chinese Society of Gastrointestinal Motility, the South East Asia Gastro-Neuro Motility Association, the Taiwan Neurogastroenterology and Motility Society and the Asian Neurogastroenterology and Motility Association, launched in January 2010 after the title change from the Korean Journal of Neurogastroenterology and Motility, published from 1994 to 2009.
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