Effect of prucalopride on intestinal gas tolerance in patients with functional bowel disorders and constipation

• Published in: Journal of gastroenterology and hepatology Vol. 32; no. 8; pp. 1457 - 1462
• Main Authors: Malagelada, Carolina, Nieto, Adoración, Mendez, Sara, Accarino, Anna, Santos, Javier, Malagelada, Juan‐R, Azpiroz, Fernando
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.08.2017
• Subjects: Benzofurans - pharmacology; Benzofurans - therapeutic use; Clinical trials; Constipation; Constipation - drug therapy; Constipation - etiology; Constipation - physiopathology; Cross-Over Studies; Double-Blind Method; Female; functional digestive symptoms; Gases - metabolism; Gastrointestinal Transit - drug effects; Humans; intestinal gas; intestinal motility; intestinal sensitivity; Intestine; Irritable Bowel Syndrome - complications; Irritable Bowel Syndrome - drug therapy; Irritable Bowel Syndrome - metabolism; Irritable Bowel Syndrome - physiopathology; Pain perception; prucalopride; Retention; Serotonin Receptor Agonists - pharmacology; Serotonin Receptor Agonists - therapeutic use; Treatment Outcome; intestinal sensitivity; prucalopride; intestinal motility; functional digestive symptoms; intestinal gas
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13733

Background and Aim Patients with functional bowel disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. Stimulation of 5HT‐4 receptors in the gut has both prokinetic and antinociceptive effects. The aim of this study is to determine the effect of prucalopride, a highly selective 5HT‐4 agonist, on gas transit and tolerance in women with functional bowel disorders complaining of constipation. Methods Twenty‐four women with functional bowel disorders complaining of constipation were included in the study. Patients were studied twice on separate days in a cross‐over design. On each study day, an intestinal gas challenge test was performed. During the five previous days, prucalopride (2 mg/day) or placebo was administered. Abdominal symptoms, stool frequency, and stool consistency were recorded during the treatment period on daily questionnaires. Results During the gas challenge test, prucalopride did not decrease the volume of gas retained in the subset of patients who had significant gas retention (≥ 200 mL) while on placebo. However, in those patients who had increased symptoms during the gas test (≥ 3 on a 0 to 6 scale) when on placebo, prucalopride did significantly reduce the perception of symptoms (2.3 ± 0.5 mean score vs 3.5 ± 0.3 on placebo; P = 0.045). During the treatment period with prucalopride, patients exhibited an increase in the total number of bowel movements and decreased stool consistency compared with placebo. Conclusion Prucalopride reduces abdominal symptoms without modifying gas retention when patients with functional bowel disorders are challenged with the gas transit and tolerance test. European Clinical Trials Database (EudraCT2011‐006354‐86).