Abstract
BackgroundIrritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide. In selected patients with severe diarrhoea-predominant or mixed IBS subtypes sacral nerve stimulation (SNS) alleviates IBS-specific symptoms and improves quality of life. The mode of action, however, remains unknown. The present study aimed to evaluate the effect of SNS on small intestinal motility in IBS patients.MethodsTwenty patients treated with SNS for severe diarrhoea-predominant or mixed IBS were included in a randomised, controlled, crossover study. The neurostimulator was turned ON or OFF for the first one month and then to the opposite setting for the next month. Gastrointestinal transit patterns were investigated with the Motility Tracking System-1 (MTS-1) at the end of each the ON and OFF period. Primary endpoint was change in the velocity of the magnetic pill within the small intestine. Statistical testing was performed with Wilcoxon’s rank sum test and Fisher’s exact test.ResultsThe median velocity of the magnetic pill through the small intestine in the fasting state was not significantly different between periods with and without SNS (Group ON-OFF: median change 0 m/h (range -1.07, 0.63), Group OFF-ON: median change 0.27 m/h (range -0.59, 1.12)) (p = 0.25). Neither, was the median velocity of the magnetic pill through the small intestine in the postprandial state significantly different between periods with and without SNS (Group ON-OFF: median change -0.13 m/h (range -0.46, 0.23), Group OFF-ON: median change 0.015 m/h (range -0.48, 0.59)) (p = 0.14).ConclusionEven though SNS may reduce symptoms of diarrhoea-predominant and mixed IBS, it has no detectable effect on small intestinal transit patterns.Trial registrationClinical.trials.gov, (NCT00919672).
Highlights
Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide
Motility Tracking System-1 (MTS-1) investigations were well tolerated by all patients and no procedure related adverse effects were observed
We observed no statistical significant difference in gastric emptying between periods with and without neurostimulation (Group ON-OFF: median change 3.5 min, Group OFF-ON: median change −33 min) (p > 0.09)
Summary
Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide. In selected patients with severe diarrhoea-predominant or mixed IBS subtypes sacral nerve stimulation (SNS) alleviates IBS-specific symptoms and improves quality of life. The aetiology of the disorder is unknown, and there are no objective markers. Sacral nerves stimulation (SNS) is a minimally invasive procedure introduced in 1995 by Matzel et al [5]. Indications have spread to include faecal incontinence secondary to anal sphincter lesions and severe cases of intractable constipation. A pilot study has indicated that temporary sacral nerve stimulation can reduce symptoms of IBS [6]. A randomised, controlled study from our group has shown that permanent SNS for severe diarrhoea-predominant or mixed IBS subtypes significantly alleviates IBS-specific symptoms and improves quality of life. SNS significantly reduces the frequency of defecation, episodes of urgency, and time spent on toilet [7]
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