Clinical Gastroenterology and Hepatology
Volume 8, Issue 1 , Pages 42-48.e1, January 2010

Citalopram Provides Little or No Benefit in Nondepressed Patients With Irritable Bowel Syndrome

  • Uri Ladabaum

      Affiliations

    • Division of Gastroenterology, University of California, San Francisco, California
    • Department of Medicine, University of California, San Francisco, California
    • Corresponding Author InformationReprint requests Address requests for reprints to: Uri Ladabaum, MD, MS, Division of Gastroenterology, S-357, Box 0538, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, California 94143-0538. fax: (415) 502-6714
    • ,
  • Annie Sharabidze

      Affiliations

    • Division of Gastroenterology, University of California, San Francisco, California
    • Department of Medicine, University of California, San Francisco, California
    • ,
  • Theodore R. Levin

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, California
    • ,
  • Wei K. Zhao

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, California
    • ,
  • Elaine Chung

      Affiliations

    • Kaiser Permanente Division of Research, Oakland, California
    • ,
  • Peter Bacchetti

      Affiliations

    • Department of Epidemiology and Biostatistics, University of California, San Francisco, California
    • ,
  • Chengshi Jin

      Affiliations

    • Department of Epidemiology and Biostatistics, University of California, San Francisco, California
    • ,
  • Barbara Grimes

      Affiliations

    • Department of Epidemiology and Biostatistics, University of California, San Francisco, California
    • ,
  • Craig J. Pepin

      Affiliations

    • The Polyclinic, Seattle, Washington

published online 18 September 2009.

Background & Aims

Data on the benefit of selective serotonin reuptake inhibitors (SSRIs) in irritable bowel syndrome (IBS) are conflicting. The longitudinal relationship between clinical symptoms and sensitivity to barostat-mediated rectal distension in IBS remains unclear. We assessed the benefit of citalopram and explored the relationships between symptoms, quality of life (QOL), and rectal sensitivity to barostat distension in non-depressed IBS patients.

Methods

Patients from primary, secondary, and tertiary care settings were randomly assigned to receive citalopram (20 mg/day for 4 weeks, then 40 mg/day for 4 weeks) or placebo in a study with double-masking and concealed allocation. Symptoms were assessed weekly, and IBS-QOL and rectal sensation by barostat were assessed at the beginning and end of the study.

Results

Patients receiving citalopram did not achieve a higher rate of adequate relief of IBS symptoms than patients receiving placebo (12/27 [44%] vs 15/27 [56%]; P = .59), regardless of IBS subtype. The odds ratio for weekly response with citalopram vs placebo was 0.80 (95% confidence interval, 0.61–1.04). Improvements in specific symptom and IBS-QOL scores were not superior for citalopram. Changes in IBS-QOL score and pressure eliciting pain showed a modest correlation (r = 0.33; 95% confidence interval, 0.03–0.57), but changes in symptoms and IBS-QOL scores or rectal sensitivity were not correlated substantially.

Conclusions

Citalopram was not superior to placebo in treating non-depressed IBS patients. Changes in symptoms were not substantially correlated with changes in rectal sensation assessed by barostat. Any benefit of citalopram in non-depressed IBS patients is likely to be modest at best.

Abbreviations used in this paper: CI, confidence interval, CONSORT, Consolidated Standards of Reporting Trials, IBS, irritable bowel syndrome, QOL, quality of life, SD, standard deviation, SSRI, selective serotonin reuptake inhibitor

 

 View this article's video abstract at www.cghjournal.org.

 Conflicts of interest The authors disclose the following: Dr Ladabaum is on the Speaker Bureaus of Novartis, Sucampo, and Takeda. The remaining authors disclose no conflicts.

 Funding This study was supported by a National Institutes of Health grant M01-RR00079, including a Clinical Associate Physician Award to Dr Ladabaum, National Institutes of Health/National Center for Research Resources (NCRR) University of California, San Francisco-Clinical and Transational Studies Institute (CTSI) grant number UL1 RR024131, and an AGA/Solvay Award for Clinical Research in Irritable Bowel Syndrome/Motility.

PII: S1542-3565(09)00891-X

doi:10.1016/j.cgh.2009.09.008

Clinical Gastroenterology and Hepatology
Volume 8, Issue 1 , Pages 42-48.e1, January 2010