2001 Abstract: 2406 Postoperative Colonic Motility is Increased and Oral Food Intake Facilitated Following Treatment with the 5-HT3 Receptor Antagonist Tropisetron in Patients After Colo-Rectal Surgery
Abstracts 2001 Digestive Disease Week
# 2406 Postoperative Colonic Motility is Increased and Oral Food Intake Facilitated Following Treatment with the 5-HT3 Receptor Antagonist Tropisetron in Patients After Colo-Rectal Surgery Martin E. Kreis, Michael Kasparek, Andreas Vogt, Horst D. Becker, Tilman T. Zittel, Ekkehard C. Jehle, Tuebingen, Germany
5-HT3 receptor antagonists are potent inhibitors of the emetic reflex by blocking 5-HT action on intestinal afferents. 5-HT is likely to be released during inflammation in the gut following abdominal surgery which may contribute to the reflex inhibition of intestinal motility causing postoperative ileus. Food intake during postoperative ileus is frequently accompanied by nausea and abdominal discomfort. We aimed to investigate whether the 5-HT3 receptor antagonist tropisetron modulates postoperative colonic motility and whether it may facilitate early postoperative food intake. 11 patients were investigated (7 m, 4 f; median age 65 years, range 19-72) who underwent a distal colonic resection with primary anastomosis. A combined 4 channel manometry and barostat catheter was placed transanally into the colon during surgery. Motility was recorded from day 1 to day 3 after surgery. Each day, following 20 minutes baseline recording, patients received 2 mg tropisetron (Navoban®) within 5 min i.v. Then, after 30 minutes, patients ingested a standardized 500 kcal meal. Recordings were terminated 60 minutes after the ingestion of the meal. Barostat bag volumes decreased on all three postoperative days following tropisetron and standard meal indicating increasing colonic tone. No abdominal discomfort or nausea was reported following the standard meal after navoban pretreatment. Bowel movements occurred at a median of 3 days postoperatively (range 2-5 days). The increase in postoperative colonic motility following tropisetron may be explained by decreased afferent sensitivity to 5-HT. This may reduce the reflex inhibition of colonic motility during postoperative ileus. Furthermore, tropisetron eliminated nausea and abdominal discomfort that was previously shown to hamper early postoperative food intake.
Postoperative colonic motility index in manometry recordings (mmHgmin-1, mean±SEM).
Postoperative day baseline tropisetron (2 mg) standard meal