Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain.
OBJECTIVE
To investigate the efficacy of amitriptyline with proton pump inhibitor (PPI) for the treatment of functional chest pain (FCP).


METHODS
This was a randomized, open-label trial investigating the addition of low dose amitriptyline (10 mg at bedtime) to a conventional dose of rabeprazole (20 mg/d) (group A, n = 20) vs a double-dose of rabeprazole (20 mg twice daily) (group B, n = 20) for patients with FCP whose symptoms were refractory to PPI. The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.


RESULTS
The between-group difference in global symptom scores was statistically significant during the last week of treatment (overall mean difference; 3.75 ± 0.31 vs 4.35 ± 0.29, the between-group difference; P < 0.001). Furthermore, 70.6% of patients in group A had their symptoms improve by > 50%, whereas only 26.3% of patients in group B had a similar treatment response (70.6% vs 26.3%, P = 0.008). Specifically, patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B (52.37 ± 17.00 vs 41.32 ± 12.34, P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84, P = 0.01, respectively).


CONCLUSIONS
Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
Se Woo
SW
Park
Hyuk
H
Lee
Hyun Jik
HJ
Lee
Jun Chul
JC
Park
Sung Kwan
SK
Shin
Sang Kil
SK
Lee
Yong Chan
YC
Lee
Ji Eun
JE
Kim
D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage*; D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage*; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D011788:Quality of Life; D064750:Rabeprazole / Q000008:administration & dosage*; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D054328:Proton Pump Inhibitors; D000639:Amitriptyline; D064750:Rabeprazole
Amitriptyline; Functional chest pain; Proton pump inhibitor