LETTER
Abuse History and Gastrointestinal Illness
Anil Minocha, MD
15 September 1996 | Volume 125 Issue 6 | Page 517
TO THE EDITOR:
I congratulate Dr. Drossman for his timely review of the management of refractory functional gastrointestinal disorders [1]. He suggests that the predominant symptom should determine the best medication (for example, loperamide for diarrhea and anticholinergic agents for pain). He recommends psychoactive medications when pain is unrelated to changes in gut function, thus downplaying the role of antidepressant agents in functional gastrointestinal disorders in the presence of gut dysfunction. Greenbaum and colleagues [2] have shown a beneficial effect of desipramine on diarrhea and on the abdominal pain in diarrhea-predominant irritable bowel syndrome. Similarly, Cannon and associates [3] have shown that imipramine relieves symptoms in patients who have chest pain despite normal coronary angiograms and regardless of abnormal results of esophageal motility and provocative testing. The mechanism of action of these drugs remains to be established.
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Author and Article Information
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University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126
1. Drossman DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med. 1995; 123:688-97.
2. Greenbaum DS, Mayle JE, Vanegeren LE, Jerome JA, Mayor JW, Greenbaum RB, et al. Effects of desipramine on irritable bowel syndrome compared with atropine and placebo. Dig Dis Sci. 1987; 32:257-66.
3. Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, et al. Imipramine in patients with chest pain despite normal angiograms. N Engl J Med. 1994; 330:1411-7.
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