Iqbal Minahil, Hira Sara, Saeed Humza, Shahid Sufyan, Butt Suha T, Rashid Kamran, Ahmad Mohammad, Hussain Hammad, Mughal Anzalna, Costa Gabriel P A, Gushken Fernanda, Nero Neil, Sengupta Shreya, Anand Akhil
Allama Iqbal Medical College, Lahore, Pakistan.
Fatima Memorial Hospital, Lahore, Pakistan.
J Neurogastroenterol Motil. 2025 Jan 31;31(1):28-37. doi: 10.5056/jnm24084.
BACKGROUND/AIMS: Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy.
A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I2 statistics.
Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, -50.72; 95% CI, -94.23 to -7.20; = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data.
Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.
背景/目的：阿米替林被用于肠易激综合征（IBS）的非适应证用药。我们进行了一项荟萃分析以评估其疗效。
截至2023年11月10日进行了一项系统的文献综述，使用MEDLINE、Embase、Cochrane图书馆和科学网来研究阿米替林对IBS患者的疗效。我们纳入了所有将阿米替林与安慰剂进行比较的随机对照试验。使用修订的Cochrane偏倚风险工具来评估研究质量。使用双变量随机效应模型进行荟萃分析。使用R软件4.2.3进行统计分析，并使用I²统计量评估异质性。
纳入了7项试验，共796例患者（61%为女性）。阿米替林与更好的治疗反应相关（比值比[OR]，5.30；95%置信区间[CI]，2.47至11.39；P<0.001），降低了肠易激综合征症状严重程度评分（平均差[MD]，-50.72；95%CI，-94.23至-7.20；P=0.020），并改善了腹泻（OR，10.55；95%CI，2.90至38.41；P<0.001）。两组在不良反应方面未观察到显著差异。3项试验显示总体偏倚风险较低，2项试验由于随机化和数据缺失显示总体偏倚风险较高，2项试验对数据缺失存在一些担忧。
与安慰剂相比，发现阿米替林在治疗IBS方面耐受性良好且有效。这些发现支持使用阿米替林治疗IBS，特别是在IBS腹泻亚型患者中。未来的研究应关注阿米替林在IBS中的剂量依赖性效应，以更好地指导临床医生制定个性化的滴定方案。
