赛庚啶在儿童功能性胃肠疾病中的应用

Cyproheptadine Use in Children With Functional Gastrointestinal Disorders.

作者信息

Madani Shailender, Cortes Orlando, Thomas Ronald

机构信息

*Carman Ann Adam Department of Pediatrics, Wayne State University School of Medicine †Department of Pediatrics, Children's Hospital of Michigan ‡Children's Research Center of Michigan, Children's Hospital of Michigan, Detroit.

出版信息

J Pediatr Gastroenterol Nutr. 2016 Mar;62(3):409-13. doi: 10.1097/MPG.0000000000000964.

DOI:10.1097/MPG.0000000000000964

PMID:26308312

Abstract

OBJECTIVE

The objective of this study was to evaluate clinical improvement and safety with use of cyproheptadine in functional gastrointestinal disorders (FGIDs) in children.

METHODS

Retrospectively evaluating the efficacy and safety of the use for indications including Rome III-defined FGIDs: functional abdominal pain, functional dyspepsia, irritable bowel syndrome (IBS), abdominal migraine, cyclic vomiting syndrome. Response categories were as follows: no improvement group/partial improvement group; requiring intervention, or complete improvement group (CIG); warranting discontinuation; ongoing use; or parental unwillingness to stop medication.

RESULTS

Among 307 patients, 151 included; 58% girls, ages 1 to 18 years (median 9); 110 (72.8%) reported complete symptom improvement; 41 (27.2%) reported no or partial improvement. Mean initial and final doses in the CIG were 4.85 mg/day (0.14 mg · kg · day) and 5.34 mg/day (0.14 mg · kg · day), respectively. A total of 102/151 (68%) reported no adverse effects. Adverse effects shown were as sleepiness in 19/151 (13%) and weight gain in 15/151 (10%). Cyproheptadine was effective in improving symptoms of functional abdominal pain, functional dyspepsia, in a relatively larger number of patients. Patients in smaller numbers had significant improvement 13/18 (72%) abdominal migraine, 10/10 (100%) IBS, and 6/8 (75%) cyclic vomiting syndrome. This is the first time report of improvement in IBS. Other pharmacodynamics had been as follows: the lower the body weight, the higher are the odds of no to partial improvement; patients in no improvement group/partial improvement group experience more adverse effects as compared to the CIG; the single best predictor of clinical improvement was body mass index. A 1 unit increase in body mass index with cyproheptadine use increased the odds of clinical improvement by 1.5-fold (P = 0.01).

CONCLUSIONS

Cyproheptadine effectively improves symptoms of Rome III-defined FGIDs and has a good safety profile when used for these indications.

摘要

目的

本研究旨在评估使用赛庚啶治疗儿童功能性胃肠病（FGIDs）的临床改善情况及安全性。

方法

回顾性评估赛庚啶用于包括罗马III型定义的FGIDs（功能性腹痛、功能性消化不良、肠易激综合征（IBS）、腹型偏头痛、周期性呕吐综合征）等适应症的疗效和安全性。反应类别如下：无改善组/部分改善组；需要干预组，或完全改善组（CIG）；需要停药组；持续用药组；或家长不愿停药组。

结果

在307例患者中，纳入151例；58%为女孩，年龄1至18岁（中位数9岁）；110例（72.8%）报告症状完全改善；41例（27.2%）报告无改善或部分改善。CIG组的初始平均剂量和最终平均剂量分别为4.85mg/天（0.14mg·kg·天）和5.34mg/天（0.14mg·kg·天）。共有102/151例（68%）报告无不良反应。出现的不良反应为19/151例（13%）嗜睡和15/151例（10%）体重增加。赛庚啶在较多患者中有效改善了功能性腹痛、功能性消化不良的症状。较少患者在腹型偏头痛（13/18例，72%）、IBS（10/10例，100%）和周期性呕吐综合征（6/8例，75%）方面有显著改善。这是关于IBS改善情况的首次报告。其他药效学情况如下：体重越低，无改善至部分改善的几率越高；无改善组/部分改善组的患者比CIG组经历更多不良反应；临床改善的唯一最佳预测指标是体重指数。使用赛庚啶时体重指数每增加1个单位，临床改善的几率增加1.5倍（P = 0.01）。