Retrospective Cohort Study
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World J Gastroenterol. Aug 28, 2014; 20(32): 11321-11325
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11321
Electrocardiograms changes in children with functional gastrointestinal disorders on low dose amitriptyline
Ashish Chogle, Miguel Saps
Ashish Chogle, Miguel Saps, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ann and Robert Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
Author contributions: Chogle A contributed to analysis and interpretation of data, drafting of the manuscript and revision of the manuscript; Saps M provided the conception and design, acquisition of data and revision of the manuscript.
Correspondence to: Ashish Chogle, MD, MPH, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ann and Robert Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 E Chicago Ave, Chicago, IL 60611, United States. achogle@luriechildrens.org
Telephone: +1-312-2274000 Fax: +1-312-2279645
Received: December 20, 2013
Revised: March 28, 2014
Accepted: May 28, 2014
Published online: August 28, 2014
Abstract

AIM: To study the effects of low dose amitriptyline on cardiac conduction in children.

METHODS: Secondary analysis of data obtained from a double-blind, randomized placebo-controlled trial, evaluating low dose amitriptyline in children with a diagnosis of functional abdominal pain, functional dyspepsia, and irritable bowel syndrome according to the Rome II criteria. Children 8-17 years of age were recruited from the pediatric gastroenterology clinics of 6 tertiary care centers in the United States. The electrocardiograms (EKGs) done prior to initiation of amitrityline and 1 mo after initiation of amitriptyline were examined. The changes in cardiac conduction were evaluated in patients and controls.

RESULTS: Thirty children were included in the study. There were 12 patients, ages 9-17 years of both genders, in the amitriptyline treatment group and 18 patients, ages 9-17 years of both genders, in the placebo treatment group. None of the patients had any baseline EKG abnormality. Amitriptyline use was associated with an increase in heart rate (P = 0.024) and QTc interval (P = 0.0107) as compared to pre-EKGs. Children in the placebo group were also noted to present a statistically significant increase in QTc interval (P = 0.0498). None of the patients developed borderline QTc prolongation or long-QT syndrome after they were started on amitriptyline.

CONCLUSION: The study findings suggest that once patients with functional gastrointestinal disorders have been screened for prolonged QTc interval on baseline EKG, they probably do not need a second EKG for reevaluation of cardiac conduction after starting low dose amitriptyline.

Keywords: Amitriptyline, Electrocardiogram, Children, Abdominal pain related-functional gastrointestinal disorders

Core tip: Information on electrocardiogram changes in children who are on low dose amitriptyline for treatment of abdominal pain associated-functional gastrointestinal disorders (AP-FGIDs) is sparse. To better understand the effects of low dose amitriptyline on cardiac conduction in children, we reviewed the electrocardiogram findings before and after initiation of amitriptyline. We found that use of low dose amitriptyline in children with AP-FGIDs was not associated with clinically significant changes in cardiac conduction.