The therapeutic efficacy of amitriptyline in irritable bowel was studied in a cross-over double-blind trial, employing fourteen patients whose symptoms were rated as Class II or worse on an arbitrarily-defined interval scale and who had not benefited from previous trials of anticholinergics, anticholinergic-sedative combinations, and bulk-forming agents. During the study, patients rated their own symptoms and the interviewer rated their symptoms using the same scale. Average scores for the patients while on drug showed significant improvement compared to pre-test level. No placebo or drug carry-over effects could be demonstrated. Inasmuch as amitriptyline is effective in this context at dosages subtherapeutic with regard to depression, the authors suggest that a central (perhaps anticholinergic) mechanism of action is responsible.
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References
1.
Irritable Bowel Syndrome, Brit. Med. J., pp. 197–198, January 22, 1972.
2.
TexterE. C. and ButlerR. C.The Irritable Bowel Syndrome, Amer. Fam. Prac., 11, pp. 169–173, 1975.
3.
ChaudharyN. A. and TrueloveS. C.The Irritable Colon Syndrome: A Study of the Clinical Features, Predisposing Causes, and Prognosis in 130 Cases, Q. J. Med., 31, pp. 307–322, 1962.
4.
GaultJ. E., Some Neurotic Syndromes, Med. J. Aust., 1, pp. 104–107, 1968.
5.
AnanthJ.Psychopharmacology and Psychosomatic Illness, Psychosomtics, 16, pp. 124–128, 1975.
6.
DiamondS.Amitriptyline in the Treatment of Gastrointestinal Diseases, Psychosomatics, 5, pp. 221–224, 1964.
7.
HonzakR.SkalaI., and PirkF.Therapeutic Use of Amitriptyline in Irritable Colon, Cesk Gastroenterol Vyz, 32, pp. 379–385, 1978.
8.
AyuzawaK. and OzawaR., Clinical Use of Tryptanol in the Treatment of Gastrointestinal Illnesses, Med. Consult. New Rem., 9, pp. 133–134, 1972.
9.
MendeloffA. I.MonkM., and SiegelC. I.Illness Experience and Life Stresses in Patients with Irritable Colon and With Ulcerative Colitis: An Epidemiologic Study of Ulcerative Colitis and Regional Enteritis in Baltimore, New Engl. J. Med., 282, pp. 14–17, 1970.
10.
DemlingL.ClassenM., and MuhlbackK., Pharmacological Response of Gastric Motility to Psychopharmacology and an Antispasmodic Drug, Gastrointestinal Motility, International Symposium on Motility of the Gastrointestinal Tract 1965, DemlingL. (ed.), Georg Thieme Verlag, Stuttgart, pp. 187–191, 1971.
11.
TerrisG., Amitriptyline dans les affections digestives functionnelles, Gazette médicale de France, 78, Paris, pp. 7192–7195, 1971.
12.
HislopI. G.Psychological Significance of the Irritable Colon Syndrome, Gut, 12, pp. 452–457, 1971.
13.
HeffernanE. W. and LippincottR. C.The Gastrointestinal Response to Stress (the Irritable Colon), Med. Clin. North Amer., 50, pp. 591–595, 1966.
14.
WhiteB. V. and JonesC. M.Mucous Colitis: A Delineation of the Syndrome with Certain Observations on its Mechanism and on the Role of Emotional Tension as a Precipitating Factor, Ann. Intern. Med., 14, pp. 854–872, 1940.
15.
FarrarJ. T., Functional Aspects of Small Bowel and Colon Motility: Diarrhea. Emotional Factors in Gastrointestional Illness, LindnerA. E. (ed.), Excerpta Medica, Amsterdam/American Elsevier Co. Inc., New York, pp. 135–140, 1973.
16.
ConnellA. M., Functional Aspects of Colonic Motility: Constipation, LindnerA. E. (ed.), Excerpta Medica, Amsterdam/American Elsevier Co. Inc., New York, pp. 141–149, 1973.
17.
MilanoA. M., Cathartic Abuse and the Cathartic Colon, LindnerA. E. (ed.), Excerpta Medica, Amsterdam/American Elsevier Co. Inc., New York, pp. 150–155, 1973.
18.
RuoffM., The Irritable Colon Syndrome, LindnerA. E. (ed.), Excerpta Medica, Amsterdam/American Elsevier Co. Inc., New York, pp. 156–165, 1973.
19.
LissJ. L.AlpersD., and WoodruffR. A.Jr.The Irritable Colon Syndrome and Psychiatric Illness, J. Clin. Psychiatry, 37, pp. 151–157, 1973.
20.
PhilipA. E. and CayE. L.Psychiatric Symptoms and Personality Traits in Patients Suffering from Gastrointestinal Illness, J. Psychosom. Res., 16, pp. 47–51, 1972.
21.
EslerM. D. and GoulstonK. J.Levels of Anxiety in Colonic Disorders, New Engl. J. Med., 288, pp. 16–20, 1973.
22.
YoungS. J.AlpersD. H., and NorlandC. C.Psychiatric Illness and the Irritable Bowel Syndrome: Practical Implications for the Primary Physician, Gastroenterology, 70, pp. 162–166, 1976.
23.
WhiteB. V.CobbS., and JonesC. M., Psychosomatic Medicine Monograph I: Mucous Colitis: A Psychological Medical Study of Sixty Cases, National Research Council, Washington, p. 96, 1938.
24.
CarsonR. C., Interpretative Manual to the MMPI: Research Developments and Clinical Applications, ButcherJ. N. (ed.), McGraw-Hill Book Company, New York, pp. 279–296, 1969.
25.
BourneP. and CuthbertJ.The Effect of Medazepam in Relieving Symptoms of Functional Gastrointestinal Distress, Aust. N. Z. J. Med., 3, pp. 457–460, 1973.
26.
KasichA. M.FeinH. P., and MillerJ. W.Comparative Effect of Phenaglycodol, Meprobamate, and a Placebo on the Irritable Colon: A Double-Blind Study, Amer. J. Dig. Dis., 4, pp. 229–234, 1959.
27.
Albornoz-PlataA.Oxypertine in the Treatment of Functional Disorders of the Digestive Tract, Gastroenterology, 66, p. 659, 1974.
28.
DotevallG. and GrollE.Controlled Clinical Trial of Mepiprazole in Irritable Bowel Syndrome, Brit. Med. J., 4, pp. 16–18, 1974.
29.
DeutschE.Relief of Anxiety and Related Emotions in Patients with Gastrointestinal Disorders: A Double-Blind Controlled Study, Amer. J. Dig. Dis., 16, pp. 1091–1094, 1971.
30.
AlmyT. P. and TulinM.Alterations in Colonic Function in Men Under Stress: Experimental Production of Changes Simulating the Irritable Colon, Gastroenterology, 8, pp. 616–626, 1947.
31.
AlmyT. P.The Stress Interview: Unfinished Business, J. Human Stress, 4: 4, pp. 3–8, 1978.
32.
WangelA. G. and DellerD. J.Intestinal Motility in Man. III. Mechanisms of Constipation and Diarrhea with Particular Reference to the Irritable Colon Syndrome, Gastroenterology, 48, pp. 69–84, 1965.
33.
Irritable Colon Syndrome Treated with an Antispasmodic Drug, A Report from the General Practitioner Research Group, Practitioner, 217, pp. 276–280, 1976.
34.
FrewE. M. S.Letter: Cimetidine and Large-Bowel Function, Lancet, 1, p. 279, 1978.
35.
EishburgJ.KruisW., and SchusslerP. P., Das irritable kolon — Syndrome: Neue therapeutische wege bei der belandlung eines haufigen krankheitsbildes, Fortschr Med., 96, pp. 2064–2070, 1978.
36.
LevyC. L.CharbonnierA., and CachinM.Bromune de pinaverium et colopathie functionnelle (étude à double insu), Sem. Hop. Paris, 53, pp. 372–374, 1977.
37.
LuttecheK.A Trial of Trimebutine in Spastic Colon, J. Int. Med. Res., 6, pp. 86–88, 1978.
38.
KjaerulffE. and TojnerH.Behandling of Colon Irritable i almeu praksis: En kontrolleret underosgelse af metoklopramid, Ugeskr Laeger, 139, pp. 2322–2325, 1977.
39.
GoodmanL. S. and GilmanA., The Pharmacological Basis of Therapeutics, Macmillan, New York, Fifth Edition, p. 527, 1975.
40.
SnyderS. H. and YamamuraH. I.Antidepressants and the Muscarinic Acetylcholine Receptor, Arch. Gen. Psychiat., 34, pp. 236–239, 1977.
41.
MessihaF. S. and MorganJ. P.Imipramine-mediated Effects on Levodopa Metabolism in Man, Biochem. Pharmacol., 23, pp. 1503–1507, 1974.
42.
PinderR. M.Doxepin-up-to-date: A Review of Its Pharmacological Properties and Therapeutic Efficacy with Particular Reference to Depression, Drugs, 13, pp. 161–218, 1977.
43.
HollisterL. E.Tricyclic Antidepressants, New Engl. J. Med., 299, pp. 1106–1109, 1978.
44.
GrossH. A.DunnerD. L., and LafleurD.Prostaglandins: A Review of Neurophysiology and Psychiatric Implications, Arch. Gen. Psychiat., 34, pp. 1189–1196, 1977.
45.
DavisJ. L.GerichJ. E., and SchultzT. A.Peripheral Diabetic Neuropathy Treated with Amitriptyline and Fluphenazine, J.A.M.A., 238, pp. 2291–2292, 1977.
46.
MasseyE. W. and RileyT. L.Tricyclic Antidepressants for Peripheral Neuropathy, J.A.M.A., 243, p. 1132, 1980.
