title: Serotonin (5-HT3) receptor antagonists for the reduction of symptoms of low anterior resection syndrome.
abstract: OBJECTIVE
  Serotonin (5-hydroxytryptamine [5-HT])3 receptor antagonists are effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), in which exaggerated intestinal/colonic hypermotility is often observed. Recent studies have suggested that the motility disorder, especially spastic hypermotility, seen in the neorectum following sphincter-preserving operations for rectal cancer may be the basis of the postoperative defecatory malfunction seen in these patients. We investigated the efficacy of 5-HT3 receptor antagonists in patients suffering from severe low anterior resection syndrome.
  
  
  METHODS
  A total of 25 male patients with complaints of uncontrollable urgency or fecal incontinence following sphincter-preserving operations were enrolled in this study. Defecatory status, assessed on the basis of incontinence score (0-20), urgency grade (0-3), and number of toilet visits per day, was evaluated using a questionnaire before and 1 month after the administration of the 5-HT3 antagonist ramosetron.
  
  
  RESULTS
  All the parameters assessed improved significantly after taking ramosetron for 1 month. The effect was more prominent in cases whose anastomotic line was lower, ie, inside the anal canal. Defecatory function was better in patients who commenced ramosetron therapy within 6 months postoperatively, as compared to those who were not prescribed ramosetron for more than 7 months postoperatively.
  
  
  CONCLUSIONS
  These results suggest that 5-HT3 antagonists are effective for the treatment of low anterior resection syndrome, as in diarrhea-predominant irritable bowel syndrome. The improvement in symptoms is not merely time dependent, but it is related to treatment with 5-HT3 antagonists.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Itagaki
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Yamazaki
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kosugi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirano
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Hidehito
authors.initials: H
authors.lastname: Arimitsu
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Risa
authors.initials: R
authors.lastname: Shiragami
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Yukino
authors.initials: Y
authors.lastname: Yoshimura
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Anesaki, Ichihara, Chiba, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Suzuki
keywords: ISR; defecatory malfunction; low anterior resection syndrome; serotonin receptor antagonist