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Citalopram of modest benefit for IBS

Does citalopram improve symptoms in patients with irritable bowel syndrome?

Does citalopram improve symptoms in patients with irritable bowel syndrome?

Synopsis

As tricyclic antidepressants have demonstrated efficacy in IBS, and because serotonin receptors are involved in colonic motor pathways, physicians are starting to try SSRIs for their patients with IBS. A total of 22 patients meeting the Rome II criteria for IBS entered this crossover study. Their mean age was 39 and 18 were women.

After a two-week washout period during which none of the participants received any medications, researchers measured their baseline symptoms (abdominal pain, bloating, stool pattern abnormalities, and overall symptom severity) using a 10cm visual scale.

Half then received citalopram 20mg per day for three weeks, followed by citalopram 40mg per day for three more weeks. Symptoms were measured by telephone at three weeks and six weeks. The other half received placebo.

After a three-week washout period, those in the placebo group received citalopram and vice versa, again with symptom measurement at three weeks and six weeks. Patients also kept a daily symptom diary.

This was a well-designed crossover study, and although small, the fact that each patient served as her or his own control gives it adequate statistical power to detect a clinically meaningful difference.

At the end of the study, the severity of abdominal pain, bloating, stool abnormalities, and global symptoms while taking citalopram improved by approximately two points more than while taking placebo on the 10-point visual scale. This is a clinically significant difference (although just barely).

Because of the obvious carryover effect observed in the study, a separate analysis of the first six weeks as a double-blind parallel arm was performed. The benefit of citalopram over placebo was confirmed. It is not clear whether patients required the increase to 40mg, since there was no direct comparison between 20mg for six weeks and 40mg for six weeks.

Level of evidence

1b (see www.infopoems.com/levels.html)

Reference

Tack J et al. A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome. Gut 2006;55:1095-1103.

Bottom line:Citalopram in a dose of 20mg daily for three weeks (perhaps increasing to 40mg at that time) modestly improves symptoms in patients with irritable bowel syndrome.

Paroxetine showed a similar benefit in a previous study, so this is likely to be a class effect of SSRIs.

This Patient Oriented Evidence that Matters (POEMs) is taken from InfoPOEMS/Inforetriever, a point of care evidence-based medicine tool, published by John Wiley. For more informatione-mail freynold@wiley.co.uk or visit www.infopoems.com

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