Prakash C, Lustman P J, Freedland K E, Clouse R E
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
Dig Dis Sci. 1998 Sep;43(9):1951-6. doi: 10.1023/a:1018878324327.
Tricyclic antidepressants (TCAs) have been used successfully in the treatment of irritable bowel syndrome and unexplained chest pain. Little information is available regarding their use in other functional gastrointestinal disorders. Clinical charts were analyzed from 37 outpatients (mean age 45 +/- 2 years, 25 females/12 males) with chronic nausea and vomiting that could not be explained by any conventional organic disorder (mean duration of symptoms 28 +/- 8 months). Twenty-one (57%) had chronic persistent symptoms; 16 (43%) had intermittent relapsing symptoms; 13 (35%) also had pain as a dominant complaint. Each patient had been treated with TCAs specifically for the gastrointestinal symptoms (amitriptyline, desipramine, nortriptyline, doxepin, or imipramine), and the subject group was followed for 5.4 +/- 1.1 months. Response (at least moderate symptom reduction using a priori chart rating criteria) occurred in 31 patients (84%), and complete symptom remission occurred in 19 (51%)--in 41% with the first TCA trial. Dose at response averaged 50 mg/day, and outcome was unrelated to TCA used. Logistic regression analysis revealed that pain dominance interfered with remission (P = 0.03), but other clinical characteristics were not predictive of outcome. This uncontrolled clinical experience indicates that the open-label response rate of functional nausea and vomiting to low dosages of TCAs resembles that noted in irritable bowel syndrome. TCAs should be studied in controlled fashion for this and related dyspeptic syndromes, as the success of other treatments is limited.
三环类抗抑郁药（TCAs）已成功用于治疗肠易激综合征和不明原因的胸痛。关于它们在其他功能性胃肠疾病中的应用，可用信息较少。对37例慢性恶心和呕吐门诊患者（平均年龄45±2岁，25名女性/12名男性）的临床病历进行了分析，这些患者的症状无法用任何传统的器质性疾病解释（症状平均持续时间28±8个月）。21例（57%）有慢性持续性症状；16例（43%）有间歇性复发症状；13例（35%）也以疼痛为主要主诉。每位患者均接受了专门针对胃肠道症状的三环类抗抑郁药治疗（阿米替林、地昔帕明、去甲替林、多塞平或丙咪嗪），并对该研究组进行了5.4±1.1个月的随访。31例患者（84%）有反应（根据预先设定的病历评分标准，症状至少有中度减轻），19例（51%）症状完全缓解——首次三环类抗抑郁药试验时缓解率为41%。有反应时的平均剂量为50毫克/天，结果与所用的三环类抗抑郁药无关。逻辑回归分析显示，以疼痛为主会干扰缓解（P = 0.03），但其他临床特征不能预测结果。这种非对照的临床经验表明，功能性恶心和呕吐对低剂量三环类抗抑郁药的开放标签反应率与肠易激综合征中观察到的相似。由于其他治疗方法的成功率有限，应采用对照方式研究三环类抗抑郁药用于此类及相关消化不良综合征的情况。
