{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:47:56Z","timestamp":1740098876118,"version":"3.37.3"},"reference-count":12,"publisher":"Aerospace Medical Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:p><jats:bold>BACKGROUND:<\/jats:bold> Functional dyspepsia is a disorder of gut\u2013brain 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.<\/jats:p>\n<jats:p><jats:bold>CASE REPORT:<\/jats:bold> 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\u2019s 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.<\/jats:p>\n<jats:p><jats:bold>DISCUSSION:<\/jats:bold> 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.<\/jats:p>\n<jats:p><jats:bold>Crutcher R, Kolasinski N. <jats:italic>Functional dyspepsia and tricyclic antidepressant use in a naval flight officer<\/jats:italic>. Aerosp Med Hum Perform. 2024; 95(6):337\u2013340.<\/jats:bold><\/jats:p>","DOI":"10.3357\/amhp.6404.2024","type":"journal-article","created":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T04:35:16Z","timestamp":1716611716000},"page":"337-340","source":"Crossref","is-referenced-by-count":0,"title":["Functional Dyspepsia and Tricyclic Antidepressant Use in a Naval Flight Officer"],"prefix":"10.3357","volume":"95","author":[{"given":"Robert","family":"Crutcher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Kolasinski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"year":"2016","series-title":"Rome IV: functional gastrointestinal disorders. Disorders of gut-brain interaction","key":"B1","unstructured":"Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE; Rome IV Committees, editors. Rome IV: functional gastrointestinal disorders. Disorders of gut-brain interaction , 4th ed. Raleigh (NC): The Rome Foundation; 2016:Appendix A."},{"issue":"10263","key":"B2","series-title":"Lancet","first-page":"1689","article-title":"Functional dyspepsia","volume":"396","author":"Ford AC","year":"2020","unstructured":"Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020; 396(10263):1689\u20131702. 10.1016\/S0140-6736(20)30469-4"},{"year":"2022","key":"B3","unstructured":"Naval Aerospace Medical Institute. U.S. Navy Aeromedical Reference and Waiver Guide. Section 10: Gastroenterology. 2022. [Accessed January 28, 2023]. Available from https:\/\/www.med.navy.mil\/Navy-Medicine-Operational-Training-Command\/Naval-Aerospace-Medical-Institute\/Aeromedical-Reference-and-Waiver-Guide\/."},{"year":"2022","key":"B4","unstructured":"Naval Aerospace Medical Institute. U.S. Navy Aeromedical Reference and Waiver Guide. Section 18: Medications. 2022. [Accessed January 28, 2023]. Available from https:\/\/www.med.navy.mil\/Navy-Medicine-Operational-Training-Command\/Naval-Aerospace-Medical-Institute\/Aeromedical-Reference-and-Waiver-Guide\/."},{"issue":"9","key":"B5","series-title":"Gut","first-page":"1284","article-title":"The brain-gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study","volume":"61","author":"Koloski NA","year":"2012","unstructured":"Koloski NA, Jones M, Kalantar J, Weltman M, Zaguirre J, Talley NJ. The brain-gut pathway in functional gastrointestinal disorders is bidirectional: a 12-year prospective population-based study. Gut. 2012; 61(9):1284\u20131290. 10.1136\/gutjnl-2011-300474"},{"issue":"2","key":"B6","series-title":"Br J Clin Pharmacol","first-page":"155","article-title":"Drowsiness, impaired performance and tricyclic antidepressants drugs","volume":"6","author":"Bye C","year":"1978","unstructured":"Bye C, Clubley M, Peck AW. Drowsiness, impaired performance and tricyclic antidepressants drugs. Br J Clin Pharmacol. 1978; 6(2):155\u2013162. 10.1111\/j.1365-2125.1978.tb00841.x"},{"issue":"5","key":"B7","series-title":"Hum Psychopharmacol","first-page":"399","article-title":"The effects of acute treatment with paroxetine, amitriptyline, and placebo on driving performance and cognitive function in healthy Japanese subjects: a double-blind crossover trial","volume":"23","author":"Iwamoto K","year":"2008","unstructured":"Iwamoto K, Takahashi M, Nakamura Y, Kawamura Y, Ishihara R. The effects of acute treatment with paroxetine, amitriptyline, and placebo on driving performance and cognitive function in healthy Japanese subjects: a double-blind crossover trial. Hum Psychopharmacol. 2008; 23(5):399\u2013407. 10.1002\/hup.939"},{"key":"B8","series-title":"Mil Med","first-page":"198","article-title":"The application of a computerized cognitive screening tool in naval aviators","volume":"186","author":"Chee SM","year":"2021","unstructured":"Chee SM, Bigornia VE, Logsdon DL. The application of a computerized cognitive screening tool in naval aviators. Mil Med. 2021; 186(Suppl. 1):198\u2013204. 10.1093\/milmed\/usaa333"},{"issue":"7","key":"B9","series-title":"Am J Gastroenterol","first-page":"988","article-title":"ACG and CAG clinical guideline: management of dyspepsia","volume":"112","author":"Moayyedi P","year":"2017","unstructured":"Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul 112(7):988\u20131013. Erratum in: Am J Gastroenterol. 2017; 112(9):1484. Erratum in: Am J Gastroenterol. 2017; 112(9):1484 10.1038\/ajg.2017.154"},{"issue":"2","key":"B10","series-title":"Gastroenterology","first-page":"340","article-title":"Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study","volume":"149","author":"Talley NJ","year":"2015","unstructured":"Talley NJ, Locke GR, Saito YA, Almazar AE, Bouras EP,  Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study. Gastroenterology. 2015; 149(2):340\u2013349.e2. 10.1053\/j.gastro.2015.04.020"},{"issue":"5","key":"B11","series-title":"World J Gastroenterol","first-page":"456","article-title":"Diet and functional dyspepsia: clinical correlates and therapeutic perspectives","volume":"26","author":"Pesce M","year":"2020","unstructured":"Pesce M, Cargiolli M, Cassarano S, Polese B, Sarnelli G,  Diet and functional dyspepsia: clinical correlates and therapeutic perspectives. World J Gastroenterol. 2020; 26(5):456\u2013465. 10.3748\/wjg.v26.i5.456"},{"issue":"11","key":"B12","series-title":"Neurogastroenterol Motil","first-page":"e13617","article-title":"Gastroparesis, metoclopramide, and tardive dyskinesia: risk revisited","volume":"31","author":"Al-Saffar A","year":"2019","unstructured":"Al-Saffar A, Lennern\u00e4s H, Hellstr\u00f6m PM. Gastroparesis, metoclopramide, and tardive dyskinesia: risk revisited. 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