Serotonin (5-HT3) receptor antagonists for the reduction of symptoms of low anterior resection syndrome

• Published in: Clinical and experimental gastroenterology Vol. 7; no. default; pp. 47 - 52
• Main Authors: Itagaki, Ryohei, Koda, Keiji, Yamazaki, Masato, Shuto, Kiyohiko, Kosugi, Chihiro, Hirano, Atsushi, Arimitsu, Hidehito, Shiragami, Risa, Yoshimura, Yukino, Suzuki, Masato
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2014; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Cancer therapies; Care and treatment; Colon; Fecal incontinence; Feces; Gastroenterology; Health aspects; Hypotheses; Irritable bowel syndrome; Medical research; Motility; Original Research; Ostomy; Patients; Quality of life; Questionnaires; Risk factors; Serotonin; Serotonin antagonists; Surgery; Japan; serotonin receptor antagonist; ISR; defecatory malfunction; low anterior resection syndrome
• ISSN: 1178-7023; 1178-7023
• DOI: 10.2147/ceg.s55410

Serotonin (5-hydroxytryptamine [5-HT])3 receptor antagonists are effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), in which exaggerated intestinal/colonic hypermotility is often observed. Recent studies have suggested that the motility disorder, especially spastic hypermotility, seen in the neorectum following sphincter-preserving operations for rectal cancer may be the basis of the postoperative defecatory malfunction seen in these patients. We investigated the efficacy of 5-HT3 receptor antagonists in patients suffering from severe low anterior resection syndrome. A total of 25 male patients with complaints of uncontrollable urgency or fecal incontinence following sphincter-preserving operations were enrolled in this study. Defecatory status, assessed on the basis of incontinence score (0-20), urgency grade (0-3), and number of toilet visits per day, was evaluated using a questionnaire before and 1 month after the administration of the 5-HT3 antagonist ramosetron. All the parameters assessed improved significantly after taking ramosetron for 1 month. The effect was more prominent in cases whose anastomotic line was lower, ie, inside the anal canal. Defecatory function was better in patients who commenced ramosetron therapy within 6 months postoperatively, as compared to those who were not prescribed ramosetron for more than 7 months postoperatively. These results suggest that 5-HT3 antagonists are effective for the treatment of low anterior resection syndrome, as in diarrhea-predominant irritable bowel syndrome. The improvement in symptoms is not merely time dependent, but it is related to treatment with 5-HT3 antagonists.