SAT a promising and novel treatment for IBS with rectal hypersensitivity: Study

USA: A recent study in the journal Clinical and Translational Gastroenterology has suggested sensory adaptation training (SAT) to be a promising novel treatment for irritable bowel syndrome with rectal hypersensitivity. 

The study found SAT to be more effective than escitalopram in improving hypersensitivity and bowel symptoms in patients with irritable bowel syndrome with predominant constipation (IBS-C). 

Rectal l hypersensitivity is associated with enhanced cortical perception and activates pain centers. Irritable bowel syndrome with constipation (IBS-C) is characterized by recurrent episodes of abdominal pain and constipation.

Satish Rao, Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA, and colleagues aimed to compare the efficacy and safety of a novel sensori-behavioral treatment, sensory adaptation training with escitalopram.

The trial included patients with IBS-C (Rome III) with rectal hypersensitivity. They were randomized to receive\ 6 biweekly sessions of SAT or escitalopram 10 mg daily for 3 months. SAT was performed by repetitive gradual distension of 10-cm long highly compliant rectal balloon above tolerability thresholds using barostat. Treatment effects on sensory thresholds and symptoms were compared. Co-primary outcome measures were those achieving improvements in rectal hypersensitivity (≥20% increase in ≥2/3 sensory thresholds) and pain (≥30% decrease).

Out of a total of 49 patients, 26 received SAT and 23 escitalopram. SAT significantly improved desire to defecate (Δ 13.5 ± 2.3 vs 2.2 ± 1.1 mm Hg) and maximum tolerability (Δ 14.8 ± 1.9 vs 1.6 ± 0.9 mm Hg) thresholds compared with escitalopram.

The results of the study were found to be:

• There were a significantly greater percentage of hypersensitivity responders with SAT than escitalopram (69% vs 17%), but not pain responders (58% vs 44%). Daily pain scores did not differ between groups or escitalopram but decreased with SAT compared with baseline.

• SAT significantly increased rectal compliance and complete spontaneous bowel movements per week than escitalopram. Five withdrew from adverse events with escitalopram and none with SAT.

Rao and the team concluded that "SAT was significantly more efficacious in improving hypersensitivity and bowel symptoms in IBS-C than escitalopram. SAT is a promising novel treatment for IBS with rectal hypersensitivity."

Reference:

Rao, Satish S.C. MD, PhD, FRCP1,2; Coss-Adame, Enrique MD1,2; Yan, Yun MD, PhD1; Erdogan, Askin MD1; Valestin, Jessica BSc2; Ayyala, Deepak Nag PhD3 Sensory Adaptation Training or Escitalopram for IBS With Constipation and Rectal Hypersensitivity: A Randomized Controlled Trial, Clinical and Translational Gastroenterology: July 2021 - Volume 12 - Issue 7 - p e00381 doi: 10.14309/ctg.0000000000000381