Effect of a calcium channel blocker and antispasmodic in diarrhoea‐predominant irritable bowel syndrome

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Abstract
Background : Irritable bowel syndrome (IBS) is a colonic function disorder. Both pinaverlum bromide (a selective calcium channel blocker) and mebeverine (an antispasmodic) are reported to be effective in the long‐term (12–16 weeks) treatment of IBS patients. Their efficacy in the short‐term treatment of IBS patients and colonic transit time is unclear. Furthermore, substance P and neuropeptide Y have either excitatory or inhibitory effects on colonic motility. Whether the efficacy of both drugs is mediated through these neuropeptides remains unknown. Methods and Results : A clinical trial was conducted with 91 patients with diarrhoea‐predominant IBS. After basal measurement of the total colonic transit time, IBS patients were randomized to receive either pinaverlum bromide (50 mg, t.i.d.) or mebeverine (100 mg, t.i.d.) for 2 weeks. The symptomatic scores regarding defaecation, total colonic transit time and serum levels of substance P and neuro‐peptide Y were measured before and after treatments. The daily defaecation frequency was markedly decreased after treatment (pinaverlum bromide, 2.9 ± 1.2 vs 2.0 ± 1.0, P < 0.05; mebeverine, 2.7 ± 1.1 vs 2.1 ± 1.0, P < 0.05). The stool consistency became well formed after both treatments (P < 0.05). Both drugs similarly improved the global well‐being in these IBS patients (pinaverlum bromide vs mebeverine 73.4 vs 71.8%, P > 0.05). The total colonic transit time was significantly prolonged only after pinaverlum bromide treatment (21.4 ± 15.5 vs 30.8 ± 14.8 h, P < 0.01). Neither substance P nor neuropeptide Y serum level was significantly changed after either treatments. Conclusion : Pinaverlum bromide and mebeverine have similar therapeutic efficacies on diarrhoeapredominant IBS patients. Prolonged colonic transit time may be one of the factors responsible for the efficacy of pinaverlum bromide on the IBS patients. Substance P and neuropeptide Y appear less important in the pathogenesis of diarrhoea‐predominant IBS.© 2000 Blackwell Science Asia Pty Ltd

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