Jackson J L, O'Malley P G, Tomkins G, Balden E, Santoro J, Kroenke K
Uniformed Services Univeristy of the Health Sciences, Bethesda, Maryland 20814, USA.
Am J Med. 2000 Jan;108(1):65-72. doi: 10.1016/s0002-9343(99)00299-5.
Functional gastrointestinal disorders are common, accounting for up to 50% of gastroenterology referrals, and several randomized controlled trials have evaluated antidepressant therapy for their treatment.
We performed a meta-analysis of published, English-language, randomized clinical trials on the use of antidepressants for the treatment of patients with functional gastrointestinal disorders.
Twelve randomized placebo-controlled trials of antidepressant treatment of functional gastrointestinal disorders were identified. One was excluded for using a combination of a tricyclic and neuroleptic agent. The medications included tricyclic antidepressants (amitriptyline [n = 3], clomipramine [n = 1], desipramine [n = 2], doxepin [n = 1], and trimipramine [n = 2]), and the antiserotonin agent, mianserin (n = 2). In addition, one trial compared two different antidepressants (mianserin and clomipramine) with placebo. Data were abstracted for the dichotomous outcome of symptom improvement in seven studies, and for the continuous variable of pain score in eight studies. The summary odds ratio for improvement with antidepressant therapy was 4.2 (95% confidence interval [CI]: 2.3 to 7.9), and the average standardized mean improvement in pain was equal to 0.9 SD units (95% CI: 0.6 to 1.2 SD units). On average 3.2 patients needed to be treated (95% CI: 2.1 to 6.5 patients) to improve 1 patient's symptom.
Treatment of functional gastrointestinal disorders with antidepressants appears to be effective. Whether this improvement is independent of an effect of treatment on depression needs further evaluation.
功能性胃肠病很常见，在胃肠病转诊病例中占比高达50%，多项随机对照试验已评估抗抑郁药对其的治疗效果。
我们对已发表的、英文的、关于使用抗抑郁药治疗功能性胃肠病患者的随机临床试验进行了荟萃分析。
共识别出12项关于抗抑郁药治疗功能性胃肠病的随机安慰剂对照试验。其中1项因使用三环类药物与抗精神病药物联合治疗而被排除。这些药物包括三环类抗抑郁药（阿米替林[n = 3]、氯米帕明[n = 1]、地昔帕明[n = 2]、多塞平[n = 1]和曲米帕明[n = 2]）以及抗血清素药物米安色林[n = 2]。此外，1项试验比较了两种不同的抗抑郁药（米安色林和氯米帕明）与安慰剂。7项研究提取了症状改善的二分法结果数据，8项研究提取了疼痛评分的连续变量数据。抗抑郁药治疗改善的汇总比值比为4.2（95%置信区间[CI]：2.3至7.9），疼痛的平均标准化平均改善等于0.9个标准差单位（95%CI：0.6至1.2个标准差单位）。平均需要治疗3.2名患者（95%CI：2.1至6.5名患者）才能使1名患者的症状得到改善。
用抗抑郁药治疗功能性胃肠病似乎是有效的。这种改善是否独立于治疗对抑郁的影响需要进一步评估。
