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A Randomized, Double-Blind, Placebo-Controlled Trial of Polyethylene Glycol Effects on Fasting and Postprandial Rectal Sensitivity and Symptoms in Hypersensitive Constipation-Predominant Irritable Bowel Syndrome.

Author(s): Awad RA, Camacho S

Affiliation(s): Experimental Medicine and Motility Unit, Gastroenterology Service U-107, Mexico City General Hospital, Mexico City, Mexico.

Publication date & source: 2009-07-03, Colorectal Dis., [Epub ahead of print]

Objective: To assess the effect of polyethylene glycol 3350 (PEG) on fasting and postprandial (PP) perception of rectal distension and symptoms in hypersensitive constipation-predominant irritable bowel syndrome (IBS-C). Design: Randomized, double-blind, placebo-controlled trial. Setting: Outpatient clinic. Patients: Forty two patients meeting Rome II criteria for IBS-C and with a pain threshold of < 32 mmHg. Intervention: Patients received either oral PEG, 3.45 g t.i.d. orally for 30 days or placebo. Main outcome measures: Rectal sensitivity was assessed before and after treatment with a barostat using the ascending method of limits, during basal and PP periods. Results: No changes in fasting and PP rectal tone and thresholds for first sensation, gas sensation, urge to defecate, and pain was observed with PEG compared to placebo. In both groups, pressure at which patients crossed the thresholds for noxious (PEG: from 28 +/- 8.8 to 22 +/- 6.9 mmHg) and non-noxious (PEG: from 16 +/- 4.9 to 12 +/- 3.6 mmHg) stimuli decreased compared with pre-treatment values. PEG improved consistency of faeces and showed a trend to diminish blood in faeces. PEG and placebo increased bowel movements per week (p<0.001), and relieved symptoms without significant side effects. Conclusions: Both PEG 3350 and placebo were clinically useful in patients with IBS-C, an effect that cannot be explained by changes in rectal tone and sensation. The results support the concept that visceral sensitivity is not stable and has a heterogeneous response to drugs, and suggest the existence of a post-healing hypersensitivity state.

Page last updated: 2009-10-20

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