Effect of citalopram on esophageal motility in healthy subjects-Implications for reflux episodes, dysphagia, and globus.

Abstract

Drugs such as citalopram, "targeting" the serotonin pathway, can alter esophageal mechano-chemical sensitivity and gastrointestinal motility. The aim of this study was to clarify the effect of citalopram on esophageal motility and sphincter function, transient lower esophageal sphincter relaxations (TLESRs), and reflux events. Sixteen healthy volunteers (HV) receiving 20mg citalopram or placebo intravenously, in a randomized cross-over fashion, underwent two high-resolution impedance manometry studies involving liquid swallows and a high-fat, high-caloric meal. Manometric, reflux, and symptom-related parameters were studied. A lower distal contractile integral was recorded under citalopram, compared with placebo (P=0.026). Upper esophageal sphincter (UES) resting pressure was significantly higher after citalopram administration throughout the study (P<0.05, all periods). Similarly, the UES postswallow mean and maximum pressures were higher in the citalopram condition (P<0.0001, in both cases) and this was also the case for the 0.2s integrated relaxation pressure (P=0.04). Esophagogastric junction resting pressures in the citalopram visit were significantly higher during swallow protocol, preprandial period, and the first postprandial hour (P<0.05, in all cases). TLESRs and total reflux events were both reduced after citalopram infusion (P=0.01, in both cases). During treatment with citalopram, five participants complained about globus sensation (P=0.06). This citalopram-induced globus was associated with higher UES postswallow mean and maximum pressure values (P=0.01 and P=0.04, respectively). Administration of citalopram exerts a diversified response on esophageal motility and sphincter function, linked to clinically relevant phenomena: a reduction in postprandial TLESRs and the induction of drug-induced globus.