Functional Dyspepsia and Tricyclic Antidepressant Use in a Naval Flight Officer

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.