Background
Tricyclic antidepressants, which have multiple pharmacological influences, have a
therapeutic effect in non-cardiac
chest pain, but
selective serotonin reuptake inhibitors have a single pharmacological effect. Aim To evaluate the acute effect of
citalopram on oesophageal
hypersensitivity. Methods On two separate occasions, 10 healthy subjects (seven men, mean age 25 years) with established oesophageal
hypersensitivity, underwent oesophageal manometry with evaluation of mechanical and chemical sensitivity. Subjects received placebo or
citalopram 20 mg i.v. in a randomized, crossover, double-blind fashion. Results
Citalopram did not alter oesophageal motility.
Citalopram significantly increased the threshold inducing first perception (4.6+/-0.3 vs. 6.7+/-0.4 mL, P<0.005) and discomfort (8.6+/-0.4 vs. 9.9+/-0.6 mL, P<0.01) during balloon distention. It also significantly prolonged the
acid perfusion time to induce perception of
heartburn (6.0+/-0.9 vs. 10.7+/-0.6 min, P<0.005) and discomfort (12.2+/-0.8 vs. 16.7+/-0.7 mL, P<0.001). Seven subjects experienced a retrosternal sensation during
edrophonium provocation with placebo, and this was reduced to two of 10 after
citalopram (P=0.02). Conclusions Acute administration of
citalopram significantly lowers chemical and mechanical oesophageal sensitivity in oesophageal
hypersensitivity, without altering the motility.