Amitriptyline ameliorates heartburn complaints in functional heartburn patients by modulating visceral perception.
ID
Source
Health condition
functional heartburn
Sponsors and support
Intervention
Outcome measures
Primary outcome
Esophageal sensitivy to acid perfusion (perfusion-related symptom score).
Secondary outcome
1. Time to symptoms during esophageal acid exposure;
2. Symptom severity during esophageal acid exposure (visual analog scale or VAS);
3. GERD symptom score improvement after an 8 week treatment with amitriptyline (GERDQ questionnaire, RDQ questionnaire, SF-LDG questionnaire);
4. Quality of life assessment (GERD-QoL questionnaire);
5. Psychological state and anxiety assessment (HADS and SF12 questionnaire).
Background summary
Many of the patients presenting with typical reflux symptoms who do not respond to the current standard of care (i.e. proton pump inhibition), do not have gastro-esophageal reflux disease. Functional heartburn is an important differential diagnosis in this respect, and can be confirmed or excluded by performing a 24h pH/impedance recording: patients with functional heartburn do not have pathological acid reflux and the symptom-reflux association analysis is typically negative. The management of functional heartburn is often challenging as evidence-based pharmacological options are not available. The use of visceral pain modulators such as tricyclic antidepressants is generally accepted, even though the clinical trials to support their use are likewise lacking. The aim of the current trial is to validate the use of amitriptylin in functional heartburn and to study its mechanism of action.
Study objective
Amitriptyline ameliorates heartburn complaints in functional heartburn patients by modulating visceral perception.
Study design
6 and 20 weeks after start of compound.
Intervention
Amitriptylin 25-50 mg daily or placebo for 6 weeks in a crossover design.
A.J. Bredenoord
Amsterdam 1105 AZ
The Netherlands
+31 (0)20 5661745
a.j.bredenoord@amc.nl
A.J. Bredenoord
Amsterdam 1105 AZ
The Netherlands
+31 (0)20 5661745
a.j.bredenoord@amc.nl
Inclusion criteria
1. Minimum age: 18 years;
2. Documented functional heartburn:
A. Negative esophagogastroduodenoscopy and no history of reflux esophagitis;
B. Negative 24h pH/impedance recording (physiological acid exposure time) and negative symptom association probability.
Exclusion criteria
1. Surgery of the esophagus;
2. Motility disorders of the GI tract leading to delayed gastric emptying or altered intestinal motility;
3. Use of any medication with a potential effect on upper gastrointestinal motility and/or sensitivity that can not be stopped for the duration of the study. If this medication can be stopped, it should be discontinued for at least 2 weeks before the start of the study;
4. Severe and clinically unstable concomitant disease (e.g. liver, cardiovascular or lung disease, neurological or psychiatric disorders, cancer or AIDS and other endocrine disorders);
5. Pregnancy or lactation. A pregnancy test will be carried out prior to inclusion in the study. Female patients who are premenopausal and have a negative pregnancy test should be on an anticonceptive;
6. Medication-related:
A. Contra-indications for amitriptyline use: epilepsy, organic central nervous system disorders, prostate hypertrophy, pyloric stenosis, cardiovascular disease, hyperthyroidism, liver- and kidney function impairment;
B. Interaction can occur with barbiturates, carbamazepine, ketoconazol and ritonavir . Concommitant use of MAO-inhibitors is contra-indicated.
7. Hypersensitivity to the active substance or to any of the excipients.
Design
Recruitment
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL3673 |
| NTR-old | NTR3843 |
| CCMO | NL43405.018.13 |
| ISRCTN | ISRCTN wordt niet meer aangevraagd. |
| OMON | NL-OMON38685 |