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

Abstract

PurposeSerotonin (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 methodsA 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.ResultsAll 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.ConclusionThese 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.

Can the POLARS tool accurately predict low anterior resection syndrome in rectal cancer patients undergoing laparoscopic resection?

“…In minor-LARS patients, medical management is advised; however, few high-quality data are available regarding this matter. Loperamide treatment for diarrhoea, 5-HT 3 receptor antagonists for postprandial urgency and incontinence, and simethicone for gas and bloating remain the treatments of choice in this group of patients [ 18 – 21 ]. Dietary restrictions, high fibre consumption, and probiotics are advised, although no data support the benefit of those agents.…”

Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management

“…Itagaki et al [25] investigated whether serotonin (5-HT3) receptor antagonists, which are known to be effective in treating patients with irritable bowel syndrome, might be effective in treating patients with LARS. Based on all parameters, including incontinence score, urgency grade, and the number of toilet visits per day, they demonstrated that 5-HT3 antagonists were effective in treating patients with LARS.…”

Effect of local ozone treatment on rats with anterior rectal resection and the possible mechanisms

“…Research has proposed that the expression of 5-HT is significantly reduced in patients with anterior rectal resection, which may be related to the pathogenesis of ARS [ 20 ]. Serotonin, a 5-HT3 receptor antagonist, has been proved to relieve the symptoms of low anterior resection syndrome [ 21 ]. The role of 5-HT in the intestinal tract is generally considered as a neurotransmitter that promotes intestine to function normally, and it is also one of the signal sources of TRPV function (a proton and heat-gated channel) mediated in the intestinal lumen [ 22 ].…”