Brief Article
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World J Gastroenterol. Nov 14, 2013; 19(42): 7455-7460
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7455
Effect of low-dose amitriptyline on globus pharyngeus and its side effects
Le-Qing You, Jing Liu, Lin Jia, Shu-Man Jiang, Gui-Qin Wang
Le-Qing You, Jing Liu, Lin Jia, Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China
Le-Qing You, Jing Liu, Lin Jia, Shu-Man Jiang, Gui-Qin Wang, Department of Gastroenterology, Guangzhou Nansha Central Hospital, Guangzhou 511457, Guangdong Province, China
Author contributions: Jia L proposed and designed the study; Wang GQ designed the randomization scheme and assessed the sample size; Liu J analyzed the data; You LQ and Jiang SM wrote the paper.
Correspondence to: Lin Jia, MD, Professor, Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, No. 1, Panfu Road, Guangzhou 510180, Guangdong Province, China. jialin@medmail.com.cn
Telephone: +86-20-81628678 Fax: +86-20-81628809
Received: July 22, 2013
Revised: September 26, 2013
Accepted: September 29, 2013
Published online: November 14, 2013
Abstract

AIM: To compare the efficacy and side effects of low-dose amitriptyline (AMT) with proton pump inhibitor treatment in patients with globus pharyngeus.

METHODS: Thirty-four patients who fulfilled the Rome III criteria for functional esophageal disorders were included in this study. Patients were randomly assigned to receive either 25 mg AMT before bedtime (AMT group) or 40 mg Pantoprazole once daily for 4 wk (conventional group). The main efficacy endpoint was assessed using the Glasgow Edinburgh Throat Scale (GETS). The secondary efficacy endpoints included the Medical Outcomes Study 36-item short form health survey [social functioning (SF)-36] and the Pittsburgh Sleep Quality Index. Treatment response was defined as a > 50% reduction in GETS scores. All patients entering this study recorded side effects at days 1, 8, 15, 22 and 29 using a visual analogue scale.

RESULTS: Thirty patients completed the study. After 4 wk of treatment, the AMT group had a greater response than the conventional group (75% vs 35.7%, P = 0.004). At day 3, the AMT group showed significantly more improvement than the Conventional group in GETS score (3.69 ± 1.14 vs 5.64 ± 1.28, P = 0.000). After 4 wk of treatment, the AMT group showed significantly greater improvement in GETS score and sleep quality than the Conventional group (1.25 ± 1.84 vs 3.79 ± 2.33, 4.19 ± 2.07 vs 8.5 ± 4.97; P < 0.01 for both). Additionally, the AMT group was more likely than the Conventional group to experience improvement in the SF-36, including general health, vitality, social functioning and mental health (P = 0.044, 0.024, 0.049 and 0.005). Dry mouth, sleepiness, dizziness and constipation were the most common side effects.

CONCLUSION: Low-dose AMT is well tolerated and can significantly improve patient symptoms, sleep and quality of life. Thus, low-dose AMT may be an effective treatment for globus pharyngeus.

Keywords: Amitriptyline, Globus pharyngeus, Side effect, Pantoprazole, Treatment response

Core tip: A literature review reveals that there is no single effective treatment for patients with globus pharyngeus. Low-dose amitriptyline (AMT) is extensively used to treat functional gastrointestinal disorders, especially in cases with prolonged severe symptoms and disorders that affect daily function. However, no data regarding the possible effects of AMT in patients with globus pharyngeus are available. In this study, we conclude that low-dose AMT is well tolerated and can significantly improve patient symptoms. Thus, we recommend the use of low-dose AMT for globus pharyngeus.