Citalopram provides little or no benefit in nondepressed patients with irritable
bowel syndrome.
Author(s): Ladabaum U, Sharabidze A, Levin TR, Zhao WK, Chung E, Bacchetti P, Jin C, Grimes
B, Pepin CJ.
Affiliation(s): Division of Gastroenterology, University of California, San Francisco,
California; Department of Medicine, University of California, San Francisco,
California, USA. uri.ladabaum@ucsf.edu
Publication date & source: 2010, Clin Gastroenterol Hepatol. , 8(1):42-48
BACKGROUND & AIMS: Data on the benefit of selective serotonin reuptake
inhibitors (SSRIs) in irritable bowel syndrome (IBS) are conflicting. The
longitudinal relationship between clinical symptoms and sensitivity to
barostat-mediated rectal distension in IBS remains unclear. We assessed the
benefit of citalopram and explored the relationships between symptoms, quality of
life (QOL), and rectal sensitivity to barostat distension in non-depressed IBS
patients.
METHODS: Patients from primary, secondary, and tertiary care settings were
randomly assigned to receive citalopram (20 mg/day for 4 weeks, then 40 mg/day
for 4 weeks) or placebo in a study with double-masking and concealed allocation.
Symptoms were assessed weekly, and IBS-QOL and rectal sensation by barostat were
assessed at the beginning and end of the study.
RESULTS: Patients receiving citalopram did not achieve a higher rate of adequate
relief of IBS symptoms than patients receiving placebo (12/27 [44%] vs 15/27
[56%]; P = .59), regardless of IBS subtype. The odds ratio for weekly response
with citalopram vs placebo was 0.80 (95% confidence interval, 0.61-1.04).
Improvements in specific symptom and IBS-QOL scores were not superior for
citalopram. Changes in IBS-QOL score and pressure eliciting pain showed a modest
correlation (r = 0.33; 95% confidence interval, 0.03-0.57), but changes in
symptoms and IBS-QOL scores or rectal sensitivity were not correlated
substantially.
CONCLUSIONS: Citalopram was not superior to placebo in treating non-depressed IBS
patients. Changes in symptoms were not substantially correlated with changes in
rectal sensation assessed by barostat. Any benefit of citalopram in non-depressed
IBS patients is likely to be modest at best.
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