Functional Dyspepsia Treatment Trial - Full Text View

Purpose

The investigators propose to examine whether antidepressant medications are efficacious in functional dyspepsia. The prescription of antidepressants to treat functional dyspepsia is based on three propositions. First, antidepressants could reduce the severity of co-morbid psychological symptoms, especially anxiety and depression. Second, antidepressants have central analgesic actions. Third, antidepressants have been shown to have local pharmacological actions on the gut, and may specifically alter gastric emptying and fundic relaxation based on preliminary data, but the relevance of such perturbations to treatment outcome is not established.

Condition	Intervention	Phase
Functional Dyspepsia	Drug: Amitriptyline Drug: escitalopram Drug: placebo	Phase 2 Phase 3

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator) Primary Purpose: Treatment
Official Title:	Antidepressant Therapy for Functional Dyspepsia

Resource links provided by NLM:

MedlinePlus related topics: Antidepressants Indigestion

Drug Information available for: Amitriptyline Amitriptyline hydrochloride Triavil Citalopram hydrobromide Citalopram Escitalopram oxalate

U.S. FDA Resources

Further study details as provided by Mayo Clinic:

Primary Outcome Measures:

Assess whether antidepressant therapy is more efficacious than placebo in relief of the symptoms of functional dyspepsia, adjusting for psychological and psychiatric co-morbidity. [ Time Frame: end of study ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Assess whether gastric emptying and the nutrient drink test is altered by therapy with a tricyclic or SSRI antidepressant. [ Time Frame: end of study ] [ Designated as safety issue: No ]
Examine whether polymorphisms of the heterotrimeric G protein and serotonin reuptake transporter predict outcome in functional dyspepsia patients receiving antidepressant therapy. [ Time Frame: end of study ] [ Designated as safety issue: No ]

Estimated Enrollment:	400
Study Start Date:	October 2006
Estimated Study Completion Date:	July 2013
Estimated Primary Completion Date:	July 2013 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 1 amitriptyline	Drug: Amitriptyline 25mg by mouth at bedtime for two weeks, then 50 mg by mouth at bedtime for 10 weeks.
Active Comparator: 2 escitalopram	Drug: escitalopram 10mg by mouth at bedtime for 12 weeks Other Name: Lexapro
Placebo Comparator: 3	Drug: placebo placebo

Detailed Description:

In a parallel group, double blind, randomized, placebo-controlled adequately powered three-arm,multi-center trial, the aims of the present study are to:

Determine whether antidepressant therapy is more efficacious than placebo in relief of the symptoms of functional dyspepsia, adjusting for psychological and psychiatric co-morbidity. The investigators will also determine if antidepressant therapy reduces disability, improves quality of life and influences clinical response over 6 months after ceasing medication.
Determine if gastric emptying (motor dysfunction) and the nutrient drink test (a test that assesses gastric hypersensitivity and/or gastric accommodation) is altered by antidepressant therapy with a tricyclic or SSRI, and whether subgroups with altered physiology are associated with treatment outcome. In a sub-study, the investigators will directly determine if impaired gastric accommodation (by a novel validated non-invasive imaging method using 99mTc-SPECT) and the symptom response to a nutrient drink test is altered by an SSRI or tricyclic antidepressant.
Determine if polymorphisms of GNβ3 and the serotonin reuptake transporter predict outcome in functional dyspepsia patients receiving a tricyclic antidepressant or SSRI therapy.

Eligibility

Ages Eligible for Study:	18 Years to 75 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients will have had in the prior 5 year, a normal esophagogastroduodenoscopy (EGD) (no esophagitis, Barrett's esophagus, cancer, erosions, or ulcer disease), and will have been diagnosed with functional dyspepsia after specialist consultation.
Patients will have failed to adequately respond to antisecretory therapy in the past for functional dyspepsia to be suitable; a good response to antisecretory therapy, which remains first line therapy, suggests underlying GERD (8).

Exclusion Criteria:

Any documented history of endoscopic esophagitis, or predominant heartburn or acid regurgitation, or these symptoms two or more times per week in the prior year, to exclude GERD.
Those who have had an adequate response to antisecretory therapy according to the physician interview, to exclude patients with disease easy to control with first line therapy or misdiagnosed GERD.
Any documented peptic ulcer disease.
Regular use of non-steroidal anti-inflammatory drugs (except long term low dose aspirin).
Subjects undergoing psychiatric treatment, having a history of drug or alcohol abuse, or currently taking psychotropic medication (psychiatric diagnoses will not be an exclusion, except for psychosis).
A history of abdominal surgery except appendectomy, cholecystectomy or hysterectomy more than one year previously.
Subjects with concurrent major physical illness (including cardiac or liver disease, diabetes, inflammatory bowel disease, glaucoma, urinary retention, active thyroid disease, vasculitis, lactose intolerance explaining symptoms), psychotic illness or eating disorder.
Subjects whose literacy skills are insufficient to complete self report questionnaires.
Pregnancy, or refusal to apply adequate contraceptive measures during the trial.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00248651

Locations

United States, Arizona
Mayo Clinic
Scottsdale, Arizona, United States, 85259
United States, Florida
Mayo Clinic Jacksonville
Jacksonville, Florida, United States, 32224
United States, Illinois
Northwestern University Chicago
Chicago, Illinois, United States, 60611
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, Missouri
Saint Louis University School of Medicine
Saint Louis, Missouri, United States, 63130
United States, New Hampshire
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire, United States, 03756
United States, Texas
Baylor College of Medicine
Houston, Texas, United States, 77030
Canada, Ontario
McMaster University Centre
Hamilton, Ontario, Canada

Sponsors and Collaborators

Mayo Clinic

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Investigators

Principal Investigator:	Earnest P Bouras, M.D.	Mayo Clinic
Principal Investigator:	John K. DiBaise, M.D.	Mayo Clinic
Principal Investigator:	Colin P Howden, M.D.	Northwestern University Chicago
Principal Investigator:	Charlene M Prather, M.D.	St. Louis University
Study Chair:	Nicholas J Talley, M.D.,Ph.D.	Mayo Clinic
Principal Investigator:	Brian E. Lacy, M.D., Ph.D.	Dartmouth-Hitchcock Medical Center
Principal Investigator:	G. R. Locke, III, M.D.	Mayo Clinic
Principal Investigator:	Bincy P Abraham, M.D., M.S.	Baylor College of Medicine
Principal Investigator:	Hashem El-Serag, M.D.	Baylor College of Medicine
Principal Investigator:	Paul Moayyedi, M.D.	McMaster University Centre, Hamilton, Ontario

More Information

No publications provided by Mayo Clinic

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Talley NJ, Locke GR 3rd, Herrick LM, Silvernail VM, Prather CM, Lacy BE, DiBaise JK, Howden CW, Brenner DM, Bouras EP, El-Serag HB, Abraham BP, Moayyedi P, Zinsmeister AR. Functional Dyspepsia Treatment Trial (FDTT): a double-blind, randomized, placebo-controlled trial of antidepressants in functional dyspepsia, evaluating symptoms, psychopathology, pathophysiology and pharmacogenetics. Contemp Clin Trials. 2012 May;33(3):523-33. Epub 2012 Feb 10.

Responsible Party:	Giles Richard Locke, III, M.D., Mayo Clinic
ClinicalTrials.gov Identifier:	NCT00248651 History of Changes
Obsolete Identifiers:	NCT00275626
Other Study ID Numbers:	2021-05 (DK65713), U01DK065713
Study First Received:	November 3, 2005
Last Updated:	November 15, 2012
Health Authority:	United States: Federal Government United States: Food and Drug Administration

Keywords provided by Mayo Clinic:

Bloating
Early Fullness
Nausea
Upper Abdominal Discomfort

dyspepsia
stomach pain
stomach discomfort

Additional relevant MeSH terms:

Dyspepsia
Gastritis
Signs and Symptoms, Digestive
Signs and Symptoms
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Stomach Diseases
Amitriptyline
Citalopram
Amitriptyline, perphenazine drug combination
Dexetimide
Antidepressive Agents, Tricyclic
Antidepressive Agents
Psychotropic Drugs

Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Adrenergic Uptake Inhibitors
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Uptake Inhibitors
Antipsychotic Agents
Tranquilizing Agents

ClinicalTrials.gov processed this record on May 16, 2013