Original ArticlesThe selective serotonin reuptake inhibitor fluoxetine does not change rectal sensitivity and symptoms in patients with irritable bowel syndrome: A double blind, randomized, placebo-controlled study☆,☆☆,★,★★
Section snippets
Study subjects
Forty patients with IBS (18 men and 22 women; age, 18-59 years; mean age, 40 ± 2 years) participated in the study. On the basis of their clinical history, 16 of 40 (40%) patients were considered as having diarrhea predominant, 11 of 40 (28%) constipation predominant, and 13 of 40 (32%) alternating type IBS. The mean duration of symptoms at entry was 5.9 ± 1 years (range, 0.3-27 years). All patients had been unsuccessfully treated previously; 32 (80%) had received bulking agents, 24 (60%)
Pressure sensitivity
In HV, MDP was 6 ± 1 mm Hg. Thresholds for first sensation, urge, and discomfort/pain during phasic, isobaric distention were 6 ± 1, 14 ± 2, and 39 ± 3 mm Hg above MDP, respectively (Table 1). The lower limit of normal for discomfort/pain, defined as the 10th percentile of the threshold for discomfort/pain in HV, was 25 mm Hg (Figure 1).
Discussion
Our study demonstrates that fluoxetine has no effects on visceral sensitivity, questioning its visceral analgesic properties in nondepressed IBS patients. In addition, no effect on IBS symptoms could be demonstrated in the entire group of treated patients. However, in patients with hypersensitivity to rectal distention, fluoxetine reduced the number of patients reporting significant abdominal pain, which was not observed in patients with normal rectal sensitivity. Future, larger clinical trials
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Address requests for reprints to: Guy Boeckxstaens, M.D., Ph.D., Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. e-mail: [email protected]; fax: (31) 20-691-7033.
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Sponsored by Eli Lilly and Company, the Netherlands, and supported by a grant from the Netherlands Digestive Diseases Foundation (MLDS), grant number WS 99-38 (to S.D.K.).
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Parts of the study have previously been published in abstract form (Gastroenterology 2002;122:A551).
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