Abstract：
BACKGROUND: Functional dyspepsia is a disorder of gut-brain interaction that has the potential to impact aviation performance. Proton pump inhibitors are well-tolerated but are only effective in one half of cases. Second-line treatments, including tricyclic antidepressants, are associated with drowsiness and are not routinely approved for use in aviators. We present a case of a Naval Flight Officer with functional dyspepsia who was successfully treated with amitriptyline and returned to flying status.CASE REPORT: A 23-yr-old male Naval Flight Officer presented with postprandial fullness and epigastric pain. His symptoms were refractory to trials of acid suppression and lifestyle modification. An extensive evaluation by Gastroenterology, including upper endoscopy, did not reveal an organic cause of his symptoms and he was diagnosed with functional dyspepsia. The patient\'s symptoms resolved with a trial of amitriptyline. Neuropsychological testing demonstrated no medication effect on cognitive performance. A waiver to resume flying duties on amitriptyline was submitted to the Naval Aerospace Medical Institute and was approved.DISCUSSION: We present the second known waiver issued in U.S. Naval aviation history for the use of amitriptyline to treat a gastrointestinal disorder. Amitriptyline is not commonly waived due to the potential for unacceptable cognitive side-effects in the flight environment. However, neuropsychological testing to assess for a possible medication effect on performance can be used to inform an aeromedical disposition and, in this case, allowed for a return to flight status.Crutcher R, Kolasinski N. Functional dyspepsia and tricyclic antidepressant use in a naval flight officer. Aerosp Med Hum Perform. 2024; 95(6):337-340.
摘要：
背景：功能性消化不良是一种可能影响航空表现的肠-脑相互作用障碍。质子泵抑制剂耐受性良好，但仅在一半病例中有效。二线治疗，包括三环抗抑郁药，与困倦有关，并且未被常规批准用于飞行员。我们介绍了一例患有功能性消化不良的海军飞行军官，他成功地用阿米替林治疗并恢复了飞行状态。案例报告：一名23岁的男性海军飞行官员出现餐后饱胀和上腹痛。他的症状对酸抑制和生活方式改变的试验难以治疗。胃肠病学的广泛评估，包括上内窥镜检查，没有发现症状的器官原因，他被诊断为功能性消化不良。患者的症状通过阿米替林试验得到缓解。神经心理学测试表明药物对认知表现没有影响。已向海军航空航天医学研究所提交了恢复对阿米替林飞行职责的豁免，并获得批准。讨论：我们提出了美国海军航空史上第二次使用阿米替林治疗胃肠道疾病的已知豁免。由于在飞行环境中潜在的不可接受的认知副作用，通常不会放弃阿米替林。然而,神经心理学测试，以评估可能的药物对性能的影响，可用于告知航空医疗处置，在这种情况下,允许返回飞行状态。CrutcherR,海军飞行军官使用功能性消化不良和三环抗抑郁药。AerospMed嗡嗡声表演。2024；95（6）：337-340。
