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Review
. 2005 Sep;54(9):1332-41.
doi: 10.1136/gut.2004.048884.

Use of psychopharmacological agents for functional gastrointestinal disorders

R E Clouse  1 , P J Lustman
Affiliations
Review

Use of psychopharmacological agents for functional gastrointestinal disorders

R E Clouse et al. Gut. 2005 Sep.
No abstract available

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Figures

Figure 1
Figure 1
New paradigms for understanding global impairment in functional gastrointestinal disorders and the potential effects of antidepressants. Factors other than gastrointestinal (GI) symptoms alone (for example, somatisation, other underlying neurophysiological mechanisms) may (A) coexist with functional gastrointestinal disorders or (B) underlie the presentation of functional gastrointestinal symptoms and have important independent effects on global well being. Antidepressants could block the independent effects of other factors on global well being or influence both the manifestation of functional gastrointestinal symptoms (for example, pain) and global well being through somewhat separate mechanisms. (Dual actions may be more representative of tricyclic antidepressants than selective serotonin reuptake inhibitors.) The effect of antidepressants on global well being is not mediated through an action on gastrointestinal symptoms alone.
Figure 2
Figure 2
Effects of antidepressants on global improvement in patients with irritable bowel syndrome (IBS). Odds ratio (OR) and associated 95% confidence interval (CI ) for each study are plotted on a logarithmic scale. Box sizes are proportional to the study’s weight in the analysis, based on study size and variance. Diamonds represents the point estimate and 95% CI for the pooled data. Open boxes represent low quality studies (quality score <3); closed boxes represent high quality studies (quality score >3). Open diamonds represent the point estimate of all studies (high and low quality); closed diamonds represent the point estimate of high quality studies only. Quality score (QS): double blind study (yes 1, no 0); sufficient number of subjects (yes 1, no 0); crossover (0) or parallel design (1); adequate definition of IBS symptoms (yes 1, no 0); presence (1) or absence (0) of intention to treat analysis. Modified from Lesbros-Pantoflickova and colleagues. Citations for the individual studies listed in the figure are provided in the original report.
Figure 3
Figure 3
An algorithm for the appropriate initiation of antidepressants in selected patients with functional gastrointestinal disorders. High degrees of somatisation can be detected by patient endorsement of many symptoms on a review of systems checklist or from features of somatisation disorder in the medical history. Contemporary antidepressants include the selective serotonin reuptake inhibitors (SSRIs). *Monitoring for toxicity with tricyclic antidepressant (TCA) levels is required if the TCA is used in conjunction with medications that interfere with normal cytochrome p450 activity, such as SSRIs. Modified from Clouse.
See this image and copyright information in PMC

References

    1. Clouse RE. Esophageal spasm syndrome. Presented at the annual meeting of the American Gastroenterological Association, San Antonio, May 1990.
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    1. Camilleri M, Heading RC, Thompson WG. Consensus report: clinical perspectives, mechanisms, diagnosis and management of irritable bowel syndrome. Aliment Pharmacol Ther 2002;16:1407–30. - PubMed

MeSH terms