Effect Of Prucalopride on Intestinal Gas Tolerance in Patients With Functional Bowel Disorders and Constipation

Background and Aim: Patients with functional bowel disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. Stimulation of 5HT-4 receptors in the gut has both prokinetic and antinociceptive effects. The aim of this study is to determine the effect of prucalopride, a highly selective 5HT-4 agonist, on gas transit and tolerance in women with functional bowel disorders complaining of constipation. Methods: Twenty-four women with functional bowel disorders complaining of constipation were included in the study. Patients were studied twice on separate days in a crossover design. On each study day, an intestinal gas challenge test was performed. During the five previous days, prucalopride (2 mg/day) or placebo was administered. Abdominal symptoms, stool frequency, and stool consistency were recorded during the treatment period on daily questionnaires. Results: During the gas challenge test, prucalopride did not decrease the volume of gas retained in the subset of patients who had significant gas retention (>= 200 mL) while on placebo. However, in those patients who had increased symptoms during the gas test (>= 3 on a 0 to 6 scale) when on placebo, prucalopride did significantly reduce the perception of symptoms (2.3 +/- 0.5 mean score vs 3.5 +/- 0.3 on placebo; P = 0.045). During the treatment period with prucalopride, patients exhibited an increase in the total number of bowel movements and decreased stool consistency compared with placebo. Conclusion: Prucalopride reduces abdominal symptoms without modifying gas retention when patients with functional bowel disorders are challenged with the gas transit and tolerance test. European Clinical Trials Database (EudraCT2011-006354-86).