The effects of sildenafil on rectal sensitivity and tone in patients with the irritable bowel syndrome

Summary Background Visceral tone supposedly affects gut sensitivity in irritable bowel syndrome (IBS). Sildenafil increases nitric oxide and influences visceral compliance. Aim To evaluate the effects of sildenafil tone inhibition on rectal sensitivity. Methods Eight controls and 21 IBS patients (Ro...

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Published in:	Alimentary pharmacology & therapeutics Vol. 35; no. 5; pp. 577 - 586
Main Authors:	Gonçalves de Medeiros, M. T., Oliveira, R. B., Santos, A. A., Leopoldino, D. M., Oliveira Lima, M. C., Arrais Nobre, R., Nobre e Souza, M. Â.
Format:	Journal Article
Language:	English
Published:	Oxford Blackwell 01-03-2012
Subjects:	Adult Biological and medical sciences Defecation - drug effects Digestive system Double-Blind Method Female Gastroenterology. Liver. Pancreas. Abdomen Humans Irritable Bowel Syndrome - complications Irritable Bowel Syndrome - drug therapy Male Medical sciences Middle Aged Mood Disorders - complications Mood Disorders - drug therapy Muscle Tonus - drug effects Muscle Tonus - physiology Nitric Oxide - metabolism Other diseases. Semiology Pain Measurement - methods Pain Threshold - drug effects Pain Threshold - physiology Pharmacology. Drug treatments Phosphodiesterase 5 Inhibitors - therapeutic use Piperazines - therapeutic use Psychiatric Status Rating Scales Purines - therapeutic use Rectum - drug effects Severity of Illness Index Sildenafil Citrate Statistics, Nonparametric Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Sulfones - therapeutic use Human Vasodilator agent 3',5'-Cyclic-GMP phosphodiesterase Enzyme Enzyme inhibitor Esterases Phosphoric diester hydrolases Rectal administration Phosphodiesterase inhibitor Phosphodiesterase 5 inhibitor Sensitivity Irritable bowel syndrome Rectum Hydrolases Digestive diseases Intestinal disease Sildenafil
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Summary:	Summary Background Visceral tone supposedly affects gut sensitivity in irritable bowel syndrome (IBS). Sildenafil increases nitric oxide and influences visceral compliance. Aim To evaluate the effects of sildenafil tone inhibition on rectal sensitivity. Methods Eight controls and 21 IBS patients (Rome II) were enrolled in a double‐blind study, after dosing with placebo or sildenafil (50 mg p.o.). Thresholds for first sensation, first desire to defecate, pain and supraliminar pain were the sensory endpoints, measured with a barostat and 600‐mL rectal bag. Pain (100‐mm VAS) and depression‐anxiety (Hamilton questionnaire) were scored. Results Irritable bowel syndrome rectal compliance and sensory‐endpoint thresholds were similar to controls. Five IBS patients had pain threshold lower than controls 95% confidence interval (hypersensitive). Depression score was greater in IBS than controls (11.9 ± 1.3 vs. 6.3 ± 2.5, P = 0.036). In IBS, pain intensity was nonsignificantly higher (37.6 ± 5.3 mm vs. 23.4 ± 8.5 mm, P = 0.064) and supraliminar pain intensity was greater (45.6 ± 5.4 mm vs. 25.9 ± 5.1 mm, P = 0.044) than controls. IBS rectal relaxation increased volume (155.4 ± 41.3 mL vs. 118.8 ± 47.7 mL, P = 0.004) and tension (193.1 ± 118.6 mmHg mL−1 vs. 133.2 ± 98.1 mmHg mL−1, P = 0.019) for triggering first desire to defecate but not for other perceptions. Sildenafil increased volume for both first desire to defecate and pain in the hypersensitive IBS patients. Sildenafil increased rectal compliance only in diarrhoea‐IBS. Mixed‐IBS obtained higher anxiety (12.9 ± 1.3 vs. 5.9 ± 3.1, P < 0.05) and depression scores (13.9 ± 1.9 vs. 6.3 ± 2.5, P < 0.05) and reported more intense supraliminar pain (53.6 ± 9.8 mm vs. 25.9 ± 5.1 mm, P < 0.05) than controls. Conclusions Rectal relaxation following dosing with sildenafil 50 mg increased the first desire to defecate threshold in IBS as a whole, but decreased pain only in the hypersensitive subset. Mixed‐IBS presented higher supraliminar pain and anxiety‐depression scores.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0269-2813 1365-2036
DOI:	10.1111/j.1365-2036.2011.04977.x