A controlled cross-over study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome

Jan Tack ^1*, Dorine Broekaert ², Benjamin Fischler ², Lukas Van Oudenhove ², Annemie Gevers ² and Jozef Janssens ²

¹ University Hospital Gasthuisberg, Belgium
² University Hospitals Leuven, Belgium

^* To whom correspondence should be addressed. E-mail: jan.tack{at}med.kuleuven.ac.be.

Accepted 12 December 2005

Abstract

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently used in the treatment of irritable bowel syndrome (IBS), although evidence of their efficacy is scarce.

Aim: Twenty three non-depressed IBS patients were recruited from a tertiary care center and included in a crossover trial comparing 6 weeks treatment with the SSRI citalopram (3 weeks 20 mg, 3 weeks 40 mg) with placebo. IBS symptom severity was the primary outcome measure, and depression and anxiety scores were also measured. The effect of acute administration of citalopram on colonic sensitivity and on colonic response to feeding was investigated as a putative predictor of symptomatic response to the drug.

Results: After 3 and 6 weeks treatment, citalopram significantly improved abdominal pain, bloating, impact of symptoms on daily life and overall well-being, compared to placebo. There was only a modest effect on stool pattern. Changes in depression or anxiety scores were not related to symptom improvement. The effect of acute administration of citalopram during a colonic barostat study did not predict clinical outcome. Analysis of the first treatment period as a double-blind parallel- arm study confirmed the benefit of citalopram over placebo.

Conclusions: The SSRI citalopram significantly improves IBS symptoms including abdominal pain, compared to placebo. The therapeutic effect is independent of effects on anxiety, depression and colonic sensorimotor funciton.

Keywords: citalopram, irritable bowel syndrome, selective serotonin reuptake inhibitor, serotonin

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