title: Tricyclic antidepressants for management of residual symptoms in inflammatory bowel disease.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Division of Gastroenterology ‡Department of Psychiatry, Washington University in St. Louis School of Medicine §John Cochran Veterans Affairs Medical Center, St. Louis, MO †Digestive Diseases, Emory University School of Medicine, Atlanta, GA.
authors.forename: Heba N
authors.initials: HN
authors.lastname: Iskandar
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cassell
authors.forename: Navya
authors.initials: N
authors.lastname: Kanuri
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gutierrez
authors.forename: Themistocles
authors.initials: T
authors.lastname: Dassopoulos
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Ciorba
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic