Antidepressants in functional esophageal disorders and GERD

A study in February's issue of Gastroenterology evaluates the effects of antidepressants in patients with functional esophageal disorders or GERD.

Patients with functional esophageal disorders present with symptoms of chest pain, heartburn, dysphagia, or globus in the absence of any structural abnormality.

Visceral hypersensitivity is a feature of these functional disorders, and might be modulated by antidepressant therapy.

Dr Pim Weijenborg and colleagues from the Netherlands evaluated evidence for the efficacy of antidepressant therapy for symptoms associated with esophageal visceral hypersensitivity in patients with functional esophageal disorders or gastroesophageal reflux disease (GERD).

The researchers performed a systematic search of the Cochrane Comprehensive Trial Register, MEDLINE, and EMBASE.

The team analyzed relevant randomized, placebo-controlled trials reporting the effect of antidepressant therapy on experimentally induced esophageal sensation or intensity, or frequency of heartburn, chest pain, dysphagia, or globus.

The team identified 378 articles; 15 described randomized controlled trials that were eligible for inclusion.

Antidepressant therapy reduced functional chest pain over a range from 18% to 67%

Gastroenterology

In addition, 1 conference abstract and 2 case reports were included, providing the best available evidence on specific symptoms.

The researchers found that esophageal pain thresholds increased by 7% to 37% after antidepressant therapy.

Antidepressant therapy reduced functional chest pain over a range from 18% to 67% and reduced heartburn in patients with GERD over a range of 23% to 61%.

The team identified 1 study that included patients with globus and none of the studies included patients with functional heartburn or functional dysphagia.

Dr Weijenborg's team concludes, "Based on a systematic review, antidepressants modulate esophageal sensation and reduce functional chest pain."

"There is limited evidence that antidepressants benefit a subgroup of patients with GERD."

"More controlled trials are needed to investigate the effects of antidepressants on functional esophageal disorders."