Tricyclic antidepressants for management of residual symptoms in inflammatory bowel disease

• Published in: Journal of clinical gastroenterology Vol. 48; no. 5; p. 423
• Main Authors: Iskandar, Heba N, Cassell, Benjamin, Kanuri, Navya, Gyawali, C Prakash, Gutierrez, Alexandra, Dassopoulos, Themistocles, Ciorba, Matthew A, Sayuk, Gregory S
• Format: Journal Article
• Language: English
• Published: United States 01.05.2014
• Subjects: Adult; Antidepressive Agents, Tricyclic - therapeutic use; Cohort Studies; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - physiopathology; Crohn Disease - drug therapy; Crohn Disease - physiopathology; Female; Humans; Irritable Bowel Syndrome - drug therapy; Irritable Bowel Syndrome - physiopathology; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Treatment Outcome
• ISSN: 1539-2031
• DOI: 10.1097/MCG.0000000000000049

Tricyclic antidepressants (TCAs) have efficacy in treating irritable bowel syndrome (IBS). Some clinicians use TCAs to treat residual symptoms in inflammatory bowel disease (IBD) patients already on decisive IBD therapy or with quiescent inflammation, although this strategy has not been formally studied. The aim of this study was to examine the efficacy of TCA therapy in IBD patients with residual symptoms, despite controlled inflammation, in a retrospective cohort study. Inclusion required initiation of TCA for persistent gastrointestinal symptoms. IBD patients had inactive or mildly active disease with persistent symptoms despite adequate IBD therapy as determined by their physician. Symptom response was compared with IBS patients. Established Likert scales were used to score baseline symptom severity (0=no symptoms, 3=severe symptoms) and TCA response (0=no improvement; 3=complete satisfaction). Eighty-one IBD [41.3±1.7 y, 56F; 58 Crohn's disease/23 ulcerative colitis (UC)] and 77 IBS (46.2±1.7 y, 60F) patients were initiated on a TCA therapy. Baseline symptom scores (IBD, 2.06±0.03; IBS, 2.12±0.04; P=0.15) and symptom response to TCA therapy (IBD, 1.46±0.09; IBS, 1.30±0.09; P=0.2) were similar in both the groups. At least moderate improvement (Likert score ≥2) on TCA was achieved by comparable proportions of patients (59.3% IBD vs. 46% IBS; P=0.09). Within IBD, response was better with UC than Crohn's disease (1.86±0.13 vs. 1.26±0.11, respectively, P=0.003). In a clinical practice setting, TCA use led to moderate improvement of residual gastrointestinal symptoms in IBD patients for whom escalation of IBD therapy was not planned. UC patients demonstrated higher therapeutic success. IBD symptom responses were similar to IBS patients.