Low-dose nocturnal tegaserod or erythromycin delays symptom recurrence after treatment of irritable bowel syndrome based on presumed bacterial overgrowth.
Our group previously demonstrated a deficiency of migrating motor complexes in irritable bowel syndrome (IBS) patients with small intestinal bacterial overgrowth (SIBO). Based on disturbed fasting motility, we tested whether low-dose nocturnal erythromycin or tegaserod can prevent the recurrence of IBS symptoms after successful antibiotic treatment.


METHODS
203 patient charts were reviewed to find IBS patients with SIBO, and treatment cycles were assessed to identify subjects with clinical and breath test resolution. The charts of those who met the inclusion criteria were reviewed to determine the method of prevention of symptom recurrence and the length of remission. The two preventive agents used were erythromycin (50 mg) or tegaserod (2-6 mg) orally at bedtime.


RESULTS
64 patients met the inclusion criteria. Subjects receiving no prevention (n=6) after successful antibiotic treatment experienced symptom recurrence after 59.7+/-47.4 days. Prevention using erythromycin (n=42) demonstrated 138.5+/-132.2 symptom-free days (P=.08 vs no prevention) compared to 241.6+/-162.2 days with tegaserod (n=16; P=.003 vs no prevention; P=.004 vs erythromycin). Switching from erythromycin to tegaserod (n=20) extended resolution from 105.8+/-73.3 days to 199.7+/-162.9 days (P=.04). Changing from no therapy to erythromycin or tegaserod (n=6) extended recurrence from 41.0+/-44.8 days to 195.6+/-153.5 days (P=.06).


CONCLUSIONS
Tegaserod significantly prevents the recurrence of IBS symptoms after antibiotic treatment compared to erythromycin or no prevention.
Pimentel
Mark
M
Dr. Pimentel serves as Director of the Gastro intestinal Motility Program at Cedars-Sinai Medical Center in Los Angeles, California.
Morales
Walter
W
Lezcano
Sheila
S
Sun-Chuan
Dai
D
Low
Kimberly
K
Yang
Janet
J