Persistent Heartburn Despite Meds – A Hypersenstive Esophagus Helped by Citalopram

Persistent esophageal symptoms (heartburn, chest pain, and regurgitation) despite ulcer meds –  could be the results of a spastic oversenstive esophagus that may respond to serotonergic agents – like antidepressant citalopram.


1. Am J Gastroenterol. 2011 May 31. [Epub ahead of print]
Selective Serotonin Reuptake Inhibitors for the Treatment of Hypersensitive Esophagus: A Randomized, Double-Blind, Placebo-Controlled Study.
Viazis N, Keyoglou A, Kanellopoulos AK, Karamanolis G, Vlachogiannakos J, Triantafyllou K, Ladas SD, Karamanolis DG.
abstract here

Persistent heartburn has always been perplexing though suspected to be related to the irritation of refluxing bile at night to which domperidone might help. See:
Indigestion – when ulcers Pills don’t work – Think Nocturnal Bile Reflex – Helped by Domperidone

  • 105 cases with positive symptoms of reflux
  • 71.5% had no excessive acid exposure found on monitoring
  • Citralopram 20 mg was used and 66.7 % cases responded versus 38.5% of control group (p= 0 .021)

Comment –  Part of chronic pain is related to the concept of hypersensitization – overly sensitive tissues that are sore even to touch. Chronic pain issues extend to esophagus. Surprising to most, is the concept that most of the bodies serotonin receptors are in the gut.  Perhaps this is one reason it may help.

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