title: Intrarectal lidocaine is an effective treatment for abdominal pain associated with diarrhea-predominant irritable bowel syndrome.
abstract: Irritable bowel syndrome (IBS) is one of the most common disorders seen by gastroenterologists. Visceral hypersensitivity is now well recognized as a clinical marker for the disease. Intrarectal lidocaine has been previously shown to decrease pain report from rectal distension in patients with IBS without any significant serum lidocaine levels. We conducted a prospective, double-blind, crossover trial on 10 patients with IBS to evaluate the effects of 300 mg intrarectal lidocaine jelly on abdominal pain. Ten Caucasian premenopausal women who met the Rome II criteria for diarrhea-predominant IBS were recruited into the study. All of the patients that participated had intermittent left lower quadrant pain and diarrhea. Each patient participated in 2 sessions in which saline jelly (placebo) and lidocaine jelly was administered on a double-blind, crossover basis. Patients participated in these sessions at a time when their ongoing pain was at least 3 on a 0 to 10 visual analogue scale. In comparison to placebo saline jelly, lidocaine jelly significantly decreased abdominal pain (P < .02) for at least 4 hours. None of the patients experienced any side effects. Intrarectal lidocaine may be a potentially useful treatment for chronic abdominal pain in IBS.
  
  
  CONCLUSIONS
  The possible presence of abnormal sodium channels in the rectal and or colonic visceral afferents of patients with IBS might serve as a clue as to the effectiveness of rectal lidocaine. The dose of lidocaine used in this study may be of sufficient strength to normalize aberrant sodium channels that may be present in the colon of patients with IBS without affecting normal sodium channels of either IBS or control subjects.
authors.affiliation: GenoMechanix, L.L.C., Gainesville, FL, USA.
authors.forename: G Nicholas
authors.initials: GN
authors.lastname: Verne
authors.forename: Arup
authors.initials: A
authors.lastname: Sen
authors.forename: Donald D
authors.initials: DD
authors.lastname: Price
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000285:Administration, Rectal; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003106:Colon / Q000187:drug effects / Q000503:physiopathology; D018592:Cross-Over Studies; D003967:Diarrhea / Q000209:etiology / Q000503:physiopathology; D004311:Double-Blind Method; D017615:Enteric Nervous System / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications*; D008012:Lidocaine / Q000008:administration & dosage*; D009475:Neurons, Afferent / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D015222:Sodium Channels / Q000187:drug effects / Q000502:physiology; D013488:Suppositories; D016896:Treatment Outcome; D017833:Visceral Afferents / Q000187:drug effects / Q000503:physiopathology
chemical_list: D000779:Anesthetics, Local; D015222:Sodium Channels; D013488:Suppositories; D008012:Lidocaine