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Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome.
Aliment Pharmacol Ther. 2009 Mar 01; 29(5):552-60.AP

Abstract

BACKGROUND

Acute physical stress causes alteration in gut autonomic function and visceral hypersensitivity in patients with irritable bowel syndrome (IBS). We have developed a model to measure this stress response.

AIM

To assess whether treatment with a drug effective in treating IBS (amitriptyline) alters the response to acute stress in IBS patients.

METHODS

Nineteen patients with IBS were given amitriptyline 25-50 mg. Patients underwent physical stress (cold pressor) test at baseline and after 3 months of treatment. Physiological parameters measured were: stress perception; systemic autonomic tone [heart rate (HR) and blood pressure (BP)]; gut specific autonomic innervation [rectal mucosal blood flow (RMBF)] and visceral sensitivity (rectal electrosensitivity).

RESULTS

Fourteen of 19 (74%) patients improved symptomatically after 3 months of amitriptyline. Acute stress induced increased perception of stress and systemic autonomic tone and reduced RMBF in symptomatic responders and nonresponders (P > 0.05 for all). All nonresponders but only 3 of 14 responders continued to exhibit stress-induced reduced pain threshold at 3 months (change from baseline -31% vs. +2%, P < 0.03 respectively).

CONCLUSION

In this open study, amitriptyline appears to decrease stress-induced electrical hypersensitivity; this effect is independent of autonomic tone. The gut response to acute stress deserves further study as a model to study drug efficacy in IBS.

Authors+Show Affiliations

GI Physiology Unit, University College Hospital, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19076934

Citation

Thoua, N M., et al. "Amitriptyline Modifies the Visceral Hypersensitivity Response to Acute Stress in the Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics, vol. 29, no. 5, 2009, pp. 552-60.
Thoua NM, Murray CD, Winchester WJ, et al. Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. Aliment Pharmacol Ther. 2009;29(5):552-60.
Thoua, N. M., Murray, C. D., Winchester, W. J., Roy, A. J., Pitcher, M. C., Kamm, M. A., & Emmanuel, A. V. (2009). Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 29(5), 552-60. https://doi.org/10.1111/j.1365-2036.2008.03918.x
Thoua NM, et al. Amitriptyline Modifies the Visceral Hypersensitivity Response to Acute Stress in the Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2009 Mar 1;29(5):552-60. PubMed PMID: 19076934.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. AU - Thoua,N M, AU - Murray,C D R, AU - Winchester,W J, AU - Roy,A J, AU - Pitcher,M C L, AU - Kamm,M A, AU - Emmanuel,A V, Y1 - 2008/12/12/ PY - 2008/12/17/entrez PY - 2008/12/17/pubmed PY - 2009/7/7/medline SP - 552 EP - 60 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 29 IS - 5 N2 - BACKGROUND: Acute physical stress causes alteration in gut autonomic function and visceral hypersensitivity in patients with irritable bowel syndrome (IBS). We have developed a model to measure this stress response. AIM: To assess whether treatment with a drug effective in treating IBS (amitriptyline) alters the response to acute stress in IBS patients. METHODS: Nineteen patients with IBS were given amitriptyline 25-50 mg. Patients underwent physical stress (cold pressor) test at baseline and after 3 months of treatment. Physiological parameters measured were: stress perception; systemic autonomic tone [heart rate (HR) and blood pressure (BP)]; gut specific autonomic innervation [rectal mucosal blood flow (RMBF)] and visceral sensitivity (rectal electrosensitivity). RESULTS: Fourteen of 19 (74%) patients improved symptomatically after 3 months of amitriptyline. Acute stress induced increased perception of stress and systemic autonomic tone and reduced RMBF in symptomatic responders and nonresponders (P > 0.05 for all). All nonresponders but only 3 of 14 responders continued to exhibit stress-induced reduced pain threshold at 3 months (change from baseline -31% vs. +2%, P < 0.03 respectively). CONCLUSION: In this open study, amitriptyline appears to decrease stress-induced electrical hypersensitivity; this effect is independent of autonomic tone. The gut response to acute stress deserves further study as a model to study drug efficacy in IBS. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/19076934/Amitriptyline_modifies_the_visceral_hypersensitivity_response_to_acute_stress_in_the_irritable_bowel_syndrome_ L2 - https://doi.org/10.1111/j.1365-2036.2008.03918.x DB - PRIME DP - Unbound Medicine ER -