Effect of citalopram on chest pain in patients with achalasia

Achalasia is a motility disorder of the esophagus. Disappearance of myenteric neurons in the esophageal wall leads to failure of relaxation of the lower esophageal sphincter (LES) and impaired peristalsis. Symptoms of achalasia include dysphagia, regurgitation, chest pain and weight loss due to the stasis of food and liquids in the esophagus. There is no cure for achalasia, the treatment focuses on decreasing the resting pressure of the LES to improve esophageal emptying. This can be achieved by pneumodilatation, surgical myotomy or per-oral endoscopic myotomy (POEM); all are safe and effective treatments for patients with achalasia. These treatments effectively diminish the symptoms dysphagia and regurgitation, however have little effect on the occurrence of chest pain. The management of recurrent chest pain in achalasia patients is challenging as 1) the underlying mechanism of chest pain in achalasia is unknown and 2) evidence-based pharmacological options are currently not available. Antidepressants are used in the treatment of pain-predominant functional disorders such as fibromyalgia, irritable bowel syndrome and several functional esophageal disorders including pain in achalasia. Antidepressants modulate esophageal sensation and reduce functional chest pain, however, although these are often prescribed this has not been studied in patients with achalasia.

Citalopram will reduce chest pain in patients with achalasia.

Two visits:
Visit 1: Baseline, Information, Informed Consent, Randomization
Treatment: 6 weeks of citalopram or placebo. Patients will be asked, throughout the whole study, to write down the frequency and the severity each symptom episode.
Visit 2: End of study

During the study period of six weeks, patients will either receive daily 20 mg of citalopram or a placebo.