Selective 5-hydroxytryptamine antagonism: a role in irritable bowel syndrome and functional dyspepsia?

BACKGROUND Abnormalities of gut motility and visceral pain perception are both thought to be involved in the pathogenesis of irritable bowel syndrome and may be susceptible to modulation by drugs affecting the various 5-HT receptor subtypes. The aim of this study was to investigate the therapeutic potential of a 5-HT3 antagonist in irritable bowel syndrome. METHODS Fifty patients with irritable bowel syndrome were treated with ondansetron, a highly selective 5-HT3 antagonist, in a double-blind, placebo-controlled cross-over study. In addition to assessing its effect on the classical symptoms of irritable bowel syndrome (abdominal pain, distension and disordered bowel habit) its effect on symptoms often seen in irritable bowel syndrome, but more commonly associated with functional dyspepsia, was also examined. RESULTS Ondansetron reduced bowel frequency (P = 0.035) and improved stool consistency (P = 0.002) in diarrhoea predominant irritable bowel syndrome and did not cause a deterioration of bowel habit in constipation predominant subjects. No statistically significant improvement was seen for abdominal pain or distension, although those patients who did respond were approximately twice as likely to be taking ondansetron than placebo. It was also found that ondansetron significantly improved the upper gastrointestinal symptoms of post-prandial epigastric discomfort (P = 0.008), flatulence (P = 0.022) and heartburn (P = 0.003). CONCLUSION The results of this study justify evaluation of the therapeutic potential of selective 5-HT antagonists in both functional dyspepsia and irritable bowel syndrome.