Editorial: Low-dose tricyclics for esophageal hypersensitivity: Is it all placebo effect?

Laurie Keefer, Peter J. Kahrilas*

*Corresponding author for this work

Research output: Contribution to journalReview article

4 Scopus citations


Limsrivilai et al. report on a randomized control trial (RCT) testing the efficacy of imipramine for treating esophageal hypersensitivity and functional heartburn, the first RCT to test this therapy in this indication. Among 43 functional heartburn and esophageal hypersensitivity patients randomized to treatment with 25 mg qhs imipramine and 40 randomized to matched placebo, the response rates, judged by a 50% reduction in gastroesophageal reflux disease symptoms, were 37.2% and 37.5%, respectively, with no observed difference between patients with hypersensitivity and those with functional heartburn. On the positive side, imipramine treatment was associated with improvement in quality of life as assessed by total SF-36 score. Although negative at first glance, there are several important lessons from this study: (i) low-dose tricyclic is sufficient in these patients; (ii) proton pump inhibitors can (and should) be discontinued when they are ineffective; and (iii) distinguishing between functional heartburn and esophageal hypersensitivity is of unclear clinical relevance.

Original languageEnglish (US)
Pages (from-to)225-227
Number of pages3
JournalAmerican Journal of Gastroenterology
Issue number2
Publication statusPublished - Feb 1 2016


ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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