Esophagus

Subject Category: Esophagus

Am J Gastroenterol 2012; 107:1662–1667; doi:10.1038/ajg.2011.179; published online 31 May 2011

Selective Serotonin Reuptake Inhibitors for the Treatment of Hypersensitive Esophagus: A Randomized, Double-Blind, Placebo-Controlled Study

Nikos Viazis MD, PhD1, Anastasia Keyoglou MD1, Alexandros K Kanellopoulos MSc2, George Karamanolis MD, PhD3, John Vlachogiannakos MD, PhD4, Konstantinos Triantafyllou MD, PhD3, Spiros D Ladas MD, PhD4 and Dimitrios G Karamanolis MD, PhD1

  1. 12nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece
  2. 2Biomedical Sciences Research Center “Al. Fleming”, Athens, Greece
  3. 32nd Department of Internal Medicine—Propaedeutic, Hepatogastroenterology Unit, Attikon University Hospital, Medical School, Athens University, Athens, Greece
  4. 41st Department of Internal Medicine—Propaedeutic, Hepatogastroenterology Division, Laiko General Hospital of Athens, Medical School, Athens University, Athens, Greece

Correspondence: Nikos Viazis, MD, PhD, 2nd Department of Gastroenterology, Evangelismos Hospital, 59 Niriidon Street, P. Faliro, Athens 17561, Greece. E-mail: nikos.viazis@gmail.com

Received 1 September 2010; Accepted 21 December 2010
Advance online publication 31 May 2011

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Abstract

OBJECTIVES:

 

Ambulatory 24-h pH–impedance monitoring can be used to assess the relationship of persistent symptoms and reflux episodes, despite proton pump inhibitor (PPI) therapy. Using this technique, we aimed to identify patients with hypersensitive esophagus and evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) on their symptoms.

METHODS:

 

Patients with normal endoscopy and typical reflux symptoms (heartburn, chest pain, and regurgitation), despite PPI therapy twice daily, underwent 24-h pH–impedance monitoring. Distal esophageal acid exposure (% time pH <4) was measured and reflux episodes were classified into acid or non-acid. A positive symptom index (SI) was declared if at least half of the symptom events were preceded by reflux episodes. Patients with a normal distal esophageal acid exposure time, but with a positive SI were classified as having hypersensitive esophagus and were randomized to receive citalopram 20mg or placebo once daily for 6 months.

RESULTS:

 

A total of 252 patients (150 females (59.5%); mean age 55 (range 18–75) years) underwent 24-h pH–impedance monitoring. Two hundred and nineteen patients (86.9%) recorded symptoms during the study day, while 105 (47.9%) of those had a positive SI (22 (20.95%) with acid, 5 (4.76%) with both acid and non-acid, and 78 (74.29%) with non-acid reflux). Among those 105 patients, 75 (71.4%) had normal distal esophageal acid exposure time and were randomized to receive citalopram 20mg (group A, n=39) or placebo (group B, n=36). At the end of the follow-up period, 15 out of the 39 patients of group A (38.5%) and 24 out of the 36 patients of group B (66.7%) continue to report reflux symptoms (P=0.021).

CONCLUSIONS:

 

Treatment with SSRIs is effective in a select group of patients with hypersensitive esophagus.