A recent randomized, double-blind, placebo-controlled crossover functional dyspepsia (FD) trial showed that 4 weeks of treatment with buspirone (10 mg TID) improved overall symptom severity, including early satiety and bloating (Clin Gastroenterol Hepatol 2012; 10: 1239-45).
This study enrolled 17 patients (13 women) with a mean age of 38.5 years. There were two 2-week treatment periods and a 2-week washout in between. Patients filled out a dyspepsia symptom score before treatment and at the conclusion. In addition, patients underwent gastric emptying by using breath tests and barostat measurement.
Overall symptom score was improved with buspirone compared to placebo: 7.5 ± 1.3 vs. 11.5 ± 1.2. Symptoms of postprandial fullness, early satiety, and abdominal bloating all improved significantly.
Buspirone treatment increased gastric accommodation compared with placebo: 229 ± 28 vs. 141 ± 32 mL respectively. Overall, gastric emptying was not affected by buspirone treatment; however, delayed emptying of liquids was evident (half-life = 64 vs. 119 minutes respectively).
The effect of buspirone on FD appears to be primarily related to improvement in gastric accommodation. Impaired accommodation has been identified in about 40% of FD patients. Buspirone which is a 5-HT1A receptor agonist acts on cholinergic nerve endings and leads to relaxation of the proximal stomach.
Buspirone also is used for the treatment of anxiety. In the present study, baseline anxiety scores were not correlated to symptom improvement but these scores were not followed at the end of treatment.
In this small study, buspirone was well tolerated and had similar adverse events as placebo. In previous studies, it has been associated with light-headedness, dizziness, and nausea.
Given the small scale of the study, it would be premature to consider buspirone a proven treatment for FD; however, this study provides the framework for larger studies to determine more conclusively the role of buspirone for FD.
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