Brief Article
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World J Gastroenterol. Aug 14, 2013; 19(30): 4958-4965
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4958
Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain
Se Woo Park, Hyuk Lee, Hyun Jik Lee, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Ji Eun Kim
Se Woo Park, Hyuk Lee, Hyun Jik Lee, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Ji Eun Kim, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Park SW performed the majority of experiments; Lee HJ, Park JC, Shic SK, Lee SK and Lee YC provided vital reagents and were also involved in editing the manuscript; Kim JE provided statistical support; Lee HJ co-ordinated and provided the collection of all the human material; Lee H and Park SW designed the study and wrote the manuscript.
Correspondence to: Hyuk Lee, MD, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. leehyuk@yuhs.ac
Telephone: +82-2-22281978 Fax: +82-2-3936884
Received: January 16, 2013
Revised: June 15, 2013
Accepted: June 28, 2013
Published online: August 14, 2013
Abstract

AIM: To investigate the efficacy of amitriptyline with proton pump inhibitor (PPI) for the treatment of functional chest pain (FCP).

METHODS: This was a randomized, open-label trial investigating the addition of low dose amitriptyline (10 mg at bedtime) to a conventional dose of rabeprazole (20 mg/d) (group A, n = 20) vs a double-dose of rabeprazole (20 mg twice daily) (group B, n = 20) for patients with FCP whose symptoms were refractory to PPI. The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.

RESULTS: The between-group difference in global symptom scores was statistically significant during the last week of treatment (overall mean difference; 3.75 ± 0.31 vs 4.35 ± 0.29, the between-group difference; P < 0.001). Furthermore, 70.6% of patients in group A had their symptoms improve by > 50%, whereas only 26.3% of patients in group B had a similar treatment response (70.6% vs 26.3%, P = 0.008). Specifically, patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B (52.37 ± 17.00 vs 41.32 ± 12.34, P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84, P = 0.01, respectively).

CONCLUSION: Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.

Keywords: Functional chest pain, Proton pump inhibitor, Amitriptyline

Core tip: Hypersensitivity and psychological problems have an important role in the pathogenesis of functional chest pain (FCP). In this regard, the principal treatment of FCP has moved towards hypersensitivity modulation and antidepressant agents on the basis that the underlying mechanisms were increased pain perception or visceral hyperalgesia in addition to psychologic causes. This is the first study to report that adding low-dose amitriptyline to a conventional dose of proton pump inhibitor (PPI) is more effective than a double-dose of PPI in patients with FCP resistant to a conventional dose of PPI treatment.