The common antidepressant amitriptyline also reduces the painful symptoms of irritable bowel syndrome

LEEDS, UK — Antidepressants may also reduce symptoms of irritable bowel syndrome (IBS) in patients under the care of a general practitioner (GP). British researchers conducted the study in primary care settings where GPs prescribed amitriptyline – whose trade names include Elavil and Vanatrip. Patients adjusted their dose based on the severity of their symptoms using a specialized adjustment document designed for the trial.

The study found that patients taking amitriptyline were nearly twice as likely to have an overall improvement in symptoms compared to those taking a placebo.

Study co-leader Alexander Ford, professor of gastroenterology at the University of Leeds School of Medicine, said: “Amitriptyline is an effective treatment for IBS that is safe and well-tolerated. “This rigorous new study indicates that GPs should support patients in primary care to try low-dose amitriptyline if their IBS symptoms do not improve with first-line treatments. hand is recommended.”

IBS affects about 1 in 20 people worldwide, causing abdominal pain and changes in bowel movements. This long-term condition, for which there is currently no cure, varies in severity over time and significantly impacts patients’ quality of life, work, and social interactions. Most available treatments have limited effectiveness, and patients often experience persistent unpleasant symptoms.

Amitriptyline belongs to a group of drugs called tricyclics. Originally used in high doses to treat depression, it is now rarely prescribed for this purpose due to the development of newer treatments.

While previous small trials showed a potential benefit of low-dose tricyclic antidepressants for IBS in hospital clinic patients with more challenging symptoms, the ATLANTIS trial was a randomized trial. First controlled trial of low-dose amitriptyline versus placebo tablets for IBS in primary care. It is also the largest trial of its kind worldwide.

Although GPs have prescribed low-dose amitriptyline for conditions such as chronic nerve pain and migraine prevention, the evidence for its effectiveness in treating IBS has so far been mixed. definitely.

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Based on the results of the ATLANTIS trial, which demonstrated a clear benefit of amitriptyline, GPs can now offer this low-dose drug to people with IBS if their symptoms do not improve with other treatments. first treatment.

Study co-lead Hazel Everitt, professor of primary care research at the University of Southampton, explains: “Before ATLANTIS, GPs often prescribed amitriptyline for IBS because the research evidence was uncertain, but research Our new study provides good evidence of benefit.”

The ATLANTIS trial enrolled 463 people with IBS from West Yorkshire, Wessex and the West of England, recruited from 55 general practices. Participants were randomly assigned to receive amitriptyline or placebo. They had control over the number of pills they took, adjusting the dosage based on IBS symptoms and any side effects using a patient dosage adjustment document created specifically for the trial.

After six months, participants taking amitriptyline reported significant improvements in their symptom scores compared with those taking placebo. They were nearly twice as likely to report an overall improvement in IBS symptoms, with amitriptyline showing superior results across different IBS symptom measures.

The researchers also monitored participants’ anxiety and depression levels, which remained constant. This suggests that the beneficial effects of amitriptyline are mainly related to its effects on the gut rather than any antidepressant properties.

No significant safety concerns were identified and side effects in people taking amitriptyline were generally mild, such as dry mouth in the morning.

“The results of this study are very encouraging,” said Andrew Farmer, director of the Health Technology Assessment Program at the National Institute for Health and Care Research. “It shows that a drug that is already widely available to treat a number of other conditions appears safe and effective for people with IBS. The findings the team has shared around dosage adjustments could be extremely useful for general practitioners in guiding them when treating patients.”

The study was published in the journal Finger tip.

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