Fenfluramine challenge test predicts outcome in pharmacological treatment of patients with functional gastrointestinal disorder.
We investigated if response to the fenfluramine challenge test could predict outcome in 47 nonpsychiatric patients with chronic functional gastrointestinal disorder (FGD) treated with mianserin, a drug closely related to mirtazepine, or placebo. Sixty milligrams of fenfluramine was given orally in the morning on nonfasting basis. Serum cortisol (COR) and prolactin (PRL) were analyzed at baseline, and after 120, 180, and 240 minutes. Patients were then randomized into a 7-week double-blind treatment trial with mianserin or placebo. Response to treatment with mianserin (76% vs.18% for placebo) was closely linked to a high increase in PRL and COR following a fenfluramine challenge test (positive predictive power=72%). Adding length of illness history increased both positive and negative predictive power to 92%. Our results indicate that the fenfluramine challenge test may be a potentially useful tool to identify nonpsychiatric subjects with FGD, who will most likely respond to treatment with a combined alpha2 and 5HT-2 and -3 antagonist.
Tanum
L
L
Department of Psychosomatic and Behavioral Medicine, National Hospital, University of Oslo, Norway. lars.tanum@rh.uio.no
Bråtveit-Johansen
K
K
Malt
U F
UF
D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003109:Colonic Diseases, Functional / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005277:Fenfluramine; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008803:Mianserin / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011388:Prolactin / Q000097:blood; D018490:Serotonin Agents; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D018490:Serotonin Agents; D012702:Serotonin Antagonists; D008803:Mianserin; D005277:Fenfluramine; D011388:Prolactin; D006854:Hydrocortisone