Evaluating the Effect of Oral Gabapentin on the Improvement of Gastrointestinal Symptoms in Patients with Functional Dyspepsia Resistant to Conventional Treatments

Shafigh-Ardestani, Mohammad-Hadi; Karami-Horestani, Mohammad; Emami, Behrokh; Arjmandpour, Akbar

Evaluating the Effect of Oral Gabapentin on the Improvement of Gastrointestinal Symptoms in Patients with Functional Dyspepsia Resistant to Conventional Treatments

Document Type : Original Article

Authors

¹ Department of Gastroenterology, Sharekord University of Medical Sciences, Shahrekord, Iran

² Department of Gastrointestinal and Liver Disease, Sharekord University of Medical Sciences, Shahrekord, Iran

³ Department of Internal Medicine, Sharekord University of Medical Sciences, Shahrekord, Iran

⁴ Department of Gastrointestinal and Liver Disease, Najafabad Islamic Azad University, Isfahan, Iran

Abstract

Background: Dyspepsia is one of the most common gastrointestinal (GI) problems and is more prevalent in adults. Environmental hypersensitivity and anxiety and depression are among the factors that can cause this disease. In this regard, gabapentin as a gamma-aminobutyric acid (GABA) analog used in the treatment of neuropathic pain and may be effective in controlling the symptoms of GI disorders. Therefore, the present study aimed to evaluate the effect of oral gabapentin on the improvement of GI symptoms in patients with functional dyspepsia (FD) resistant to conventional treatments. Materials and Methods: In a double-blind clinical trial, 126 patients with FD resistant to conventional treatments, referred to gastroenterology clinic of Hajar Hospital of Shahrekord in 2017–2018, were randomly assigned to two groups; patients in the control group received omeprazole alone, and the case group received omeprazole plus gabapentin. The severity of GI symptoms was recorded and evaluated by the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire before and after treatment (4 weeks). Results: GSRS total score in the group who received gabapentin (16.89 ± 6.89) was significantly lower than controls (20.00 ± 9.31) (P = 0.036). It also found that gabapentin, as an adjunctive drug, plus omeprazole could play a significant role in GI symptom improvement, such as pain, reflux, and indigestion. Conclusion: Gabapentin as an adjunctive drug could be more effective in reducing the severity of GI symptoms in patients with dyspepsia, especially neurological symptoms (such as pain, reflux, and indigestion)

Keywords

References

1.	Talley NJ, Ford AC. Functional dyspepsia. N Engl J Med 2015;373:1853-63.
2.	Lacy BE, Talley NJ, Locke GR 3^rd, Bouras EP, DiBaise JK, El-Serag HB, et al. Review article: Current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther 2012;36:3-15.
3.	Stein DJ, Bruce Lydiard R, Herman BK, Mandel FS. Impact of gastrointestinal symptoms on response to pregabalin in generalized anxiety disorder: Results of a six-study combined analysis. Int Clin Psychopharmacol 2009;24:126-32.
4.	Goa KL, Sorkin EM. Gabapentin. A review of its pharmacological properties and clinical potential in epilepsy. Drugs 1993;46:409-27.
5.	Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial. JAMA 1998;280:1837-42.
6.	Talley NJ, Meineche-Schmidt V, Paré P, Duckworth M, Räisänen P, Pap A, et al. Efficacy of omeprazole in functional dyspepsia: Double-blind, randomized, placebo-controlled trials (the bond and opera studies). Aliment Pharmacol Ther 1998;12:1055-65.
7.	Chou R. Pharmacological management of low back pain. Drugs 2010;70:387-402.
8.	Mearin F, Cucala M, Azpiroz F, Malagelada JR. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 1991;101:999-1006.
9.	Lydiard RB. Irritable bowel syndrome, anxiety, and depression: What are the links? J Clin Psychiatry 2001;62 Suppl 8:38-45.
10.	Lydiard RB, Pitrosky B, Hackett D, White C. Impact of gastrointestinal symptom severity on response to venlafaxine extended-release in patients with generalized anxiety disorder. J Clin Psychiatry 2004;65:838-44.
11.	Gottrup H, Juhl G, Kristensen AD, Lai R, Chizh BA, Brown J, et al. Chronic oral gabapentin reduces elements of central sensitization in human experimental hyperalgesia. Anesthesiology 2004;101:1400-8.
12.	Gale JD, Houghton LA. Alpha 2 delta (α(2)δ) ligands, gabapentin and pregabalin: What is the evidence for potential use of these ligands in irritable bowel syndrome. Front Pharmacol 2011;2:28.
13.	Mazaheri M, SadatKhoshouei M. Comparison between psychometric characteristics of persian version of the gastrointestinal symptoms rating scale in functional gastrointestinal disorders and normal groups. GOVARESH 2012;17:18-24.
14.	Lee KJ, Kim JH, Cho SW. Gabapentin reduces rectal mechanosensitivity and increases rectal compliance in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2005;22:981-8.
15.	Feldman M, Friedman LS, Brandt LJ. Sleisenger and fordtran's gastrointestinal and liver disease E-Book: pathophysiology, diagnosis, management, expert consult premium edition-enhanced online features. Philadelphia, PA: Elsevier Health Sciences; 2010.
16.	Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Saudi J Anaesth 2014;8:374-7.
17.	Bafna U, Goyal VK, Garg A. A comparison of different doses of gabapentin to attenuate the haemodynamic response to laryngoscopy and tracheal intubation in normotensive patients. J Anaesthesiol Clin Pharmacol 2011;27:43-6. [PUBMED] [Full text]
18.	Yaksi A, Ozgönenel L, Ozgönenel B. The efficiency of gabapentin therapy in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 2007;32:939-42.
19.	Rose MA, Kam PC. Gabapentin: Pharmacology and its use in pain management. Anaesthesia 2002;57:451-62.
20.	Houghton LA, Fell C, Whorwell PJ, Jones I, Sudworth DP, Gale JD, et al. Effect of a second-generation alpha2delta ligand (pregabalin) on visceral sensation in hypersensitive patients with irritable bowel syndrome. Gut 2007;56:1218-25.
21.	Camilleri M, Bueno L, de Ponti F, Fioramonti J, Lydiard RB, Tack J. Pharmacological and pharmacokinetic aspects of functional gastrointestinal disorders. Gastroenterology 2006;130:1421-34.
22.	Spiller R, Aziz Q, Creed F, Emmanuel A, Houghton L, Hungin P, et al. Guidelines on the irritable bowel syndrome: Mechanisms and practical management. Gut 2007;56:1770-98.
23.	Ghai A, Gupta M, Hooda S, Singla D, Wadhera R. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy. Saudi J Anaesth 2011;5:252-7.
24.	Gianesello L, Pavoni V, Barboni E, Galeotti I, Nella A. Perioperative pregabalin for postoperative pain control and quality of life after major spinal surgery. J Neurosurg Anesthesiol 2012;24:121-6.
25.	Yildirim K, Deniz O, Gureser G, Karatay S, Ugur M, Erdal A, et al. Gabapentin monotherapy in patients with chronic radiculopathy: The efficacy and impact on life quality. J Back Musculoskelet Rehabil 2009;22:17-20.
26.	Grice GR, Mertens MK. Gabapentin as a potential option for treatment of sciatica. Pharmacotherapy 2008;28:397-402.
27.	Liu LS, Shenoy M, Pasricha PJ. The analgesic effects of the GABAB receptor agonist, baclofen, in a rodent model of functional dyspepsia. Neurogastroenterol Motil 2011;23:356-61, e160-1.
28.	Cervero F, Laird JM. Role of ion channels in mechanisms controlling gastrointestinal pain pathways. Curr Opin Pharmacol 2003;3:608-12.

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