title: Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study.
abstract: OBJECTIVE
  Ambulatory 24-h pH-impedance monitoring can be used to assess the relationship of persistent symptoms and reflux episodes, despite proton pump inhibitor (PPI) therapy. Using this technique, we aimed to identify patients with hypersensitive esophagus and evaluate the effect of selective serotonin reuptake inhibitors (SSRIs) on their symptoms.
  
  
  METHODS
  Patients with normal endoscopy and typical reflux symptoms (heartburn, chest pain, and regurgitation), despite PPI therapy twice daily, underwent 24-h pH-impedance monitoring. Distal esophageal acid exposure (% time pH <4) was measured and reflux episodes were classified into acid or non-acid. A positive symptom index (SI) was declared if at least half of the symptom events were preceded by reflux episodes. Patients with a normal distal esophageal acid exposure time, but with a positive SI were classified as having hypersensitive esophagus and were randomized to receive citalopram 20 mg or placebo once daily for 6 months.
  
  
  RESULTS
  A total of 252 patients (150 females (59.5%); mean age 55 (range 18-75) years) underwent 24-h pH-impedance monitoring. Two hundred and nineteen patients (86.9%) recorded symptoms during the study day, while 105 (47.9%) of those had a positive SI (22 (20.95%) with acid, 5 (4.76%) with both acid and non-acid, and 78 (74.29%) with non-acid reflux). Among those 105 patients, 75 (71.4%) had normal distal esophageal acid exposure time and were randomized to receive citalopram 20 mg (group A, n=39) or placebo (group B, n=36). At the end of the follow-up period, 15 out of the 39 patients of group A (38.5%) and 24 out of the 36 patients of group B (66.7%) continue to report reflux symptoms (P=0.021).
  
  
  CONCLUSIONS
  Treatment with SSRIs is effective in a select group of patients with hypersensitive esophagus.
authors.affiliation: 2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece. nikos.viazis@gmail.com
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Keyoglou
authors.forename: Alexandros K
authors.initials: AK
authors.lastname: Kanellopoulos
authors.forename: George
authors.initials: G
authors.lastname: Karamanolis
authors.forename: John
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Karamanolis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015283:Citalopram / Q000627:therapeutic use*; D004311:Double-Blind Method; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D010919:Placebos; D054328:Proton Pump Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors