Irritable Bowel Syndrome

Background:

Irritable Bowel Syndrome (IBS) is a gastrointestinal syndrome characterized by chronic pain and irregular bowl movement with the absence of organ cause. IBS could be diarrhea-predominate or constipation-predominate. One of the pathophysiology that thought to cause IBS diarrhea-predominate (IBS-D) is a high level of serotonin especially after the meals. There are two type of serotonin that involve in the gastrointestinal system, type 3 (HT3) and type 4 (HT4). The purpose of this study is to evaluate the efficacy of ondansetron, which is a selective 5-HT3-receptor antagonist that have been used as antiemitc agent, in the treatment IBS-D.

Literature search strategy:

A literature search was conducted in Pubmed using the following MeSH terms: ondansetron, IBS, treatment. The drug terms were combined with the remaining terms with the boolean operator "and". This was then limited to the English language, last five years and human. A total of 2 articles was identified. Of these, 1 met the following criteria: randomized control trial and assessed the effectiveness of using ondansetron in the treatment of IBS-D. The other article was excluded because it was not relevant to the question.

Literature analysis:

A randomized trial of ondansetron for the treatment of irritable bowel syndrome with diarrhea, was a two-centre, double-blind, placebo controlled crossover study of ondansetron 4 mg/tablet versus placebo. The inclusion criteria of the study were age 18–75 years, IBS-D patients meeting the Rome III criteria, women of childbearing age should agree to have contraception during the study, no evidence of inflammatory bowel disease/microscopic colitis and able to give informed consent. The exclusion criteria were pregnancy or br...

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...gency score was significantly lower in ondansetron comparing to placebo −0.32 (−0.45 to −0.18) <0.001, but there was no statistical significant deference between ondansetron and placebo −0.13 (−0.27 to 0.01) P=0.070. PPA showed same result as ITT.

The only frequently occurring side effect was constipation, which occurred in 9% on ondansetron and 2% on placebo. Other less frequent side effects which included headache, rectal bleeding, backache and abdominal pain, were almost the same between the two groups.

Conclusions:

Ondansetron showed a clinically effectiveness in changing the stool form and decrease the urgency of deification, but no improvement in term of pain. Also, it showed a well tolerated side effect that could be decrease by dose reduction. So, for patients with IBS-D who complain from stool urgency, ondansetron will be a great treatment options for them.