New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline.
BACKGROUND
In functional gastrointestinal (GI) disorders including functional dyspepsia (FD) and irritable bowel syndrome (IBS), there might be no small extent of contributions of psychosomatic factors. As a therapy for IBS patients, the effectiveness of antidepressants has been reported.


OBJECTIVE
In this study, we evaluated the efficacy of H2-receptor antagonist (famotidine) and 5-HT4 receptor agonist (mosapride citrate). In addition, the effect of antidepressants was assessed as the second-step therapy.


METHODS
Patients complaining upper GI symptoms were diagnosed as FD excluding organic diseases. Randomized patients received 20 mg/day of famotidine or 15 mg/day of mosapride citrate for 4 weeks and the efficacy was compared between the two groups based on a 10-point visual analogue scale. When symptoms were not relieved (score improvement 0-2 points), patients received amitriptyline (30 mg/day) or no medication for 4 weeks randomly. Patients who had depression in psychological test (SDS) were omitted.


RESULTS
As the first-step therapy, both famotidine and mosapride showed beneficial effects regardless of FD subtypes, age and gender. The efficacy of these two drugs in relieving FD symptoms was not significantly different. In patients who failed in the first-step therapy, amitriptyline showed beneficial effects.


CONCLUSIONS
These findings might be clinically important in view of the efficient relief of symptoms in FD patients.
Otaka
M
M
Department of Internal Medicine, Akita University School of Medicine, Hondu, Akita, Japan. otaka@med.akita-u.ac.jp
Jin
M
M
Odashima
M
M
Matsuhashi
T
T
Wada
I
I
Horikawa
Y
Y
Komatsu
K
K
Ohba
R
R
Oyake
J
J
Hatakeyama
N
N
Watanabe
S
S
D000368:Aged; D000639:Amitriptyline / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000188:drug therapy*; D015738:Famotidine / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009025:Morpholines / Q000627:therapeutic use*; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use
D000929:Antidepressive Agents, Tricyclic; D001549:Benzamides; D005765:Gastrointestinal Agents; D009025:Morpholines; D017366:Serotonin Receptor Agonists; D000639:Amitriptyline; D015738:Famotidine; C062720:mosapride