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

Authors Itagaki R, Koda K, Yamazaki M, Shuto K, Kosugi C, Hirano A, Arimitsu H, Shiragami R, Yoshimura Y, Suzuki M

Received 4 October 2013

Accepted for publication 18 November 2013

Published 11 March 2014 Volume 2014:7 Pages 47—52

DOI https://doi.org/10.2147/CEG.S55410

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4


Ryohei Itagaki, Keiji Koda, Masato Yamazaki, Kiyohiko Shuto, Chihiro Kosugi, Atsushi Hirano, Hidehito Arimitsu, Risa Shiragami, Yukino Yoshimura, Masato Suzuki

Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan

Purpose: 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.
Patients and methods: 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.
Results: 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.
Conclusion: 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.

Keywords: low anterior resection syndrome, serotonin receptor antagonist, ISR, defecatory malfunction

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