Gorard D A, Libby G W, Farthing M J
Department of Gastroenterology, St Bartholomew's Hospital, West Smithfield, London, UK.
Aliment Pharmacol Ther. 1994 Apr;8(2):159-66. doi: 10.1111/j.1365-2036.1994.tb00273.x.
Antidepressants are used in the treatment of irritable bowel syndrome but it is unclear whether any symptomatic improvement is due solely to correction of an associated affective disorder, or whether these drugs have effects on bowel function which may be of therapeutic benefit. Intestinal transit is known to be abnormal in some irritable bowel syndrome patients.
We have studied the effects of imipramine, a tricyclic antidepressant with mixed pharmacological properties, and paroxetine, a selective 5-hydroxytryptamine re-uptake inhibitor, on intestinal transit times.
Median (range) whole gut transit time was lower in 10 diarrhoea-predominant irritable bowel syndrome patients, 22.2 (3.6-51.6) h, compared to 28 control subjects 39.6 (7.2-68.4) h, (P < 0.05). Similarly, orocaecal transit time was shorter at 55 (30-90) min in diarrhoea-predominant irritable bowel syndrome patients compared to 75 (40-150) min in controls, (P < 0.05). Four days' administration of imipramine increasing to a daily dose of 100 mg prolonged both orocaecal and whole gut transit times in 12 control subjects and six diarrhoea-predominant irritable bowel syndrome patients. In contrast, 30 mg paroxetine daily for 4 days reduced orocaecal transit time in ten controls and eight irritable bowel syndrome patients, but had no effect on whole gut transit time.
Short-term administration of antidepressants alters intestinal transit, but the selective 5-hydroxytryptamine re-uptake inhibitor, paroxetine, has different effects to the tricyclic drug, imipramine. These effects on transit precede any effects on mood. Although there is a high prevalence of affective disorder in irritable bowel syndrome clinic patients, these drugs may have additional therapeutic actions on the gut. These actions might be taken into account when prescribing antidepressants in irritable bowel syndrome.
抗抑郁药用于治疗肠易激综合征，但尚不清楚症状的改善是否仅归因于相关情感障碍的纠正，或者这些药物是否对肠道功能有治疗有益的作用。已知一些肠易激综合征患者的肠道转运异常。
我们研究了具有混合药理特性的三环类抗抑郁药丙咪嗪和选择性5-羟色胺再摄取抑制剂帕罗西汀对肠道转运时间的影响。
10例腹泻型肠易激综合征患者的中位（范围）全肠道转运时间为22.2（3.6 - 51.6）小时，低于28例对照受试者的39.6（7.2 - 68.4）小时，（P < 0.05）。同样，腹泻型肠易激综合征患者的口盲肠转运时间较短，为55（30 - 90）分钟，而对照组为75（40 - 150）分钟，（P < 0.05）。对12例对照受试者和6例腹泻型肠易激综合征患者给予丙咪嗪4天，剂量增加至每日100毫克，可延长口盲肠和全肠道转运时间。相比之下，10例对照受试者和8例肠易激综合征患者每日服用30毫克帕罗西汀，持续4天，可缩短口盲肠转运时间，但对全肠道转运时间无影响。
短期服用抗抑郁药会改变肠道转运，但选择性5-羟色胺再摄取抑制剂帕罗西汀与三环类药物丙咪嗪的作用不同。这些对转运的影响先于对情绪的任何影响。虽然肠易激综合征门诊患者中情感障碍的患病率很高，但这些药物可能对肠道有额外的治疗作用。在为肠易激综合征患者开抗抑郁药时，可能需要考虑这些作用。
