A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea
Background: Irritable bowel syndrome with diarrhoea (IBS-D) is particularly debilitating due to urgency and episodic incontinence. Some 5-hydroxytryptamine 3 (5-HT3) receptor antagonists (5-HT3RAs) have proven effective but have serious side effects. Ondansetron, also a 5-HT3RA, has been widely used...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
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BMJ Publishing Group
2013
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| Online Access: | https://eprints.nottingham.ac.uk/3087/ |
| _version_ | 1848790950627770368 |
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| author | Garsed, Klara Chernova, Julia Hastings, Margaret Lam, Ching Marciani, Luca Singh, Gulzar Henry, Amanda P. Hall, Ian P. Whorwell, Peter Spiller, Robin C. |
| author_facet | Garsed, Klara Chernova, Julia Hastings, Margaret Lam, Ching Marciani, Luca Singh, Gulzar Henry, Amanda P. Hall, Ian P. Whorwell, Peter Spiller, Robin C. |
| author_sort | Garsed, Klara |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: Irritable bowel syndrome with diarrhoea (IBS-D) is particularly debilitating due to urgency and episodic incontinence. Some 5-hydroxytryptamine 3 (5-HT3) receptor antagonists (5-HT3RAs) have proven effective but have serious side effects. Ondansetron, also a 5-HT3RA, has been widely used as an antiemetic with an excellent safety record for over two decades. Our aim was to assess its effectiveness in IBS-D.
Methods: 120 patients meeting Rome III criteria for IBS-D entered a randomised, double-blind, placebo-controlled crossover study of 5 weeks of ondansetron 4 mg versus placebo with dose titration allowed, up to two tablets three times daily in the first 3 weeks. Patients completed daily diaries documenting stool consistency using the Bristol Stool Form score. Gut transit was measured in the last week of each treatment. The primary endpoint was average stool consistency in the last 2 weeks of treatment.
Results: Ondansetron significantly improved stool consistency (mean difference in stool form between ondansetron and placebo −0.9, 95% CI −1.1 to −0.6, p<0.001). Compared with placebo, patients on ondansetron experienced fewer days with urgency (p<0.001), lower urgency scores (p<0.001), reduced frequency of defaecation (p=0.002) and less bloating (p=0.002), although pain scores did not change significantly. IBS symptom severity score fell more with ondansetron than placebo (83±9.8 vs 37±9.7, p=0.001). 65% reported adequate relief with ondansetron but not placebo compared with 14% reporting relief with placebo but not ondansetron, relative risk 4.7, 95% CI 2.6 to 8.5, p<0.001.
Conclusions: Ondansetron relieves some of the most intrusive symptoms of IBS-D, namely loose stools, frequency and urgency. |
| first_indexed | 2025-11-14T18:20:45Z |
| format | Article |
| id | nottingham-3087 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:20:45Z |
| publishDate | 2013 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-30872024-08-15T15:14:42Z https://eprints.nottingham.ac.uk/3087/ A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea Garsed, Klara Chernova, Julia Hastings, Margaret Lam, Ching Marciani, Luca Singh, Gulzar Henry, Amanda P. Hall, Ian P. Whorwell, Peter Spiller, Robin C. Background: Irritable bowel syndrome with diarrhoea (IBS-D) is particularly debilitating due to urgency and episodic incontinence. Some 5-hydroxytryptamine 3 (5-HT3) receptor antagonists (5-HT3RAs) have proven effective but have serious side effects. Ondansetron, also a 5-HT3RA, has been widely used as an antiemetic with an excellent safety record for over two decades. Our aim was to assess its effectiveness in IBS-D. Methods: 120 patients meeting Rome III criteria for IBS-D entered a randomised, double-blind, placebo-controlled crossover study of 5 weeks of ondansetron 4 mg versus placebo with dose titration allowed, up to two tablets three times daily in the first 3 weeks. Patients completed daily diaries documenting stool consistency using the Bristol Stool Form score. Gut transit was measured in the last week of each treatment. The primary endpoint was average stool consistency in the last 2 weeks of treatment. Results: Ondansetron significantly improved stool consistency (mean difference in stool form between ondansetron and placebo −0.9, 95% CI −1.1 to −0.6, p<0.001). Compared with placebo, patients on ondansetron experienced fewer days with urgency (p<0.001), lower urgency scores (p<0.001), reduced frequency of defaecation (p=0.002) and less bloating (p=0.002), although pain scores did not change significantly. IBS symptom severity score fell more with ondansetron than placebo (83±9.8 vs 37±9.7, p=0.001). 65% reported adequate relief with ondansetron but not placebo compared with 14% reporting relief with placebo but not ondansetron, relative risk 4.7, 95% CI 2.6 to 8.5, p<0.001. Conclusions: Ondansetron relieves some of the most intrusive symptoms of IBS-D, namely loose stools, frequency and urgency. BMJ Publishing Group 2013-12-12 Article PeerReviewed Garsed, Klara, Chernova, Julia, Hastings, Margaret, Lam, Ching, Marciani, Luca, Singh, Gulzar, Henry, Amanda P., Hall, Ian P., Whorwell, Peter and Spiller, Robin C. (2013) A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut . ISSN 1468-3288 (In Press) http://dx.doi.org/10.1136/gutjnl-2013-305989 doi:10.1136/gutjnl-2013-305989 doi:10.1136/gutjnl-2013-305989 |
| spellingShingle | Garsed, Klara Chernova, Julia Hastings, Margaret Lam, Ching Marciani, Luca Singh, Gulzar Henry, Amanda P. Hall, Ian P. Whorwell, Peter Spiller, Robin C. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title | A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title_full | A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title_fullStr | A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title_full_unstemmed | A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title_short | A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| title_sort | randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea |
| url | https://eprints.nottingham.ac.uk/3087/ https://eprints.nottingham.ac.uk/3087/ https://eprints.nottingham.ac.uk/3087/ |