EVALUATION OF EFFECTIVENESS OF AMITRIPTYLINE AND PROTON PUMP INHIBITORS AS COMBINATION THERAPY FOR REFRACTORY GLOBUS PHARYNGEUS

Abstract

Introduction:Introduction: Globus pharyngeus is characterised by a feeling of a lump in the throat that can be alleviated by eating and does not involve pain or trouble with swallowing. It presents continuous difficulties because of its persistent character, lack of response to standard therapies, and significant influence on one's quality of life. Developing consistent diagnostic and treatment guidelines for globus pharyngeus is difficult because its cause is not clear. Higher doses of the tricyclic antidepressant Amitriptyline are limited by side effects, but lower doses have shown to be effective and well tolerated for functional gastrointestinal disorders. Early attempts to use larger amounts of AMT for treating globus pharyngeus were frequently stopped because of adverse reactions, leading to further examination of smaller doses. This study aims to investigate the clinical indicators of symptom relief by combining lower-dose AMT with PPIs for globus pharyngeus patients, given the limited evidence on its effectiveness.

Materials and Methods:This research utilised a prospective RCT design, which is widely acknowledged as the most reliable method for evaluating treatment efficacy in clinical studies. Approval from the hospital ethics committee was acquired, and participants gave written informed consent before joining. Patients with globus pharyngeus, determined through thorough clinical assessment and endoscopy, were included in the study if conventional therapies had not shown improvement after six months. Thirty-four individuals were assigned randomly to receive either a combination of amitriptyline and pantoprazole or pantoprazole alone through computer-generated random selection. The evaluation criteria consisted of the Glasgow Edinburgh Throat Scale (GETS) for initial examination and the Pittsburgh Sleep Quality Index (PSQI) for further assessment. Data was systematically collected using standardised forms, and analysis was conducted using rigorous statistical methods like ANOVA and regression. Findings were presented as mean ± SD, with P < 0.05 considered statistically significant for better understanding of treatment results.

Results:Four weeks later, the AMT group exhibited a greater response rate (75% compared to 35.7%, with P = 0.004) and notable enhancements in GETS scores on days 3, 10, and week 4 (all with P < 0.01). AMT also had a notable enhancement on PSQI in comparison to baseline and the Conventional group (P = 0.008), indicating its promise in improving sleep quality for globus pharyngeus patients.

Discussion and conclusion: Low doses of AMT demonstrate promise in treating globus pharyngeus and enhancing quality of life. More extensive studies with larger groups of participants and longer monitoring periods are necessary to confirm its effectiveness and safety, guiding evidence-based recommendations and enhancing patient treatment.