Adapted from BMJ 2-9 Nov 2024
I have prescribed Amitriptyline for years for irritable bowel syndrome so I was pleased to see this article that showed a recent RCT gave good results, with the hope that General Practitioners will use it more often.
First line treatments for irritable bowel syndrome include removal of the offending foodstuffs from the diet and the prescription of medication for such symptoms as constipation, diarrhea, and abdominal spasms. Should these not work, low dose anti-depressants including SSRIs and Amitriptyline may be used. This study named ATLANTIS compared Amitriptyline with placebo in patients who had not responded to dietary and simple prescriptions for symptoms.
The study took place in England over 55 practices. Patients described their symptoms as moderate to severe. The average age was 49 and 68% were female. 232 patients were randomised to take the active drug and the other 231 took and identical placebo for six months. The dose was 10mg in the evening increasing to two or three a day depending on symptom control and side effects. Dietary advice from the GPs continued. 338 patients completed the whole six months trial, 75% of the active drug group and 71% of the placebo group. A questionnaire was given to assess symptoms towards the completion of the study.
The Amitriptyline group score for symptoms improved by 99 points compared to 69 points in the placebo group. 61% of the active group reported relief from their symptoms compared to 45% in the placebo group. 58% of the active group thought the treatment was acceptable, compared to 47% in the placebo group. The anxiety, depression, work and social adjustment scores were similar in each group. 20% of the active drug group dropped out of the study compared to 26% in the placebo group.
The active drug users had more of a dry mouth and drowsiness but less insomnia than the active group. There were two “serious” adverse effects in the active group, compared to three in the placebo group. At six months 74% of the active group were still on the medication compared to 68% of the placebo group.
The researchers have said that this is the largest ever trial of Amitriptyline in irritable bowel syndrome. The drug is cheap, reduces symptom severity, is safe and is well tolerated. They hope that this drug will be considered more often for this debilitating condition.
My comment: a low carb diet with removal of wheat from the diet can also improve irritable bowel syndrome and acid reflux.
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