Randomized, double-blind, placebo-controlled trial of prednisolone in post-infectious irritable bowel syndrome
Article first published online: 7 JUL 2003
Alimentary Pharmacology & Therapeutics
Volume 18, Issue 1, pages 77–84, July 2003
How to Cite
Dunlop, S. P., Jenkins, D., Neal, K. R., Naesdal, J., Borgaonker, M., Collins, S. M. and Spiller, R. C. (2003), Randomized, double-blind, placebo-controlled trial of prednisolone in post-infectious irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 18: 77–84. doi: 10.1046/j.1365-2036.2003.01640.x
- Issue published online: 7 JUL 2003
- Article first published online: 7 JUL 2003
- Accepted for publication 16 April 2003
Background : Post-infectious irritable bowel syndrome is associated with increased serotonin-containing enterochromaffin cells and lymphocytes in rectal biopsies. Animal studies have suggested that steroids reduce the lymphocyte response and suppress some of the post-infectious changes in neuromuscular function.
Aim : To evaluate whether steroids reduce the number of enterochromaffin cells and improve the symptoms of post-infectious irritable bowel syndrome.
Methods : Twenty-nine patients with post-infectious irritable bowel syndrome underwent a randomized, double-blind, placebo-controlled trial of 3 weeks of oral prednisolone, 30 mg/day. Mucosal enterochromaffin cells, T lymphocytes and mast cells were assessed in rectal biopsies before and after treatment, and bowel symptoms were recorded in a daily diary.
Results: Initial enterochromaffin cell counts were increased and correlated with initial lamina propria T-lymphocyte counts (r = 0.460, P = 0.014). Enterochromaffin cell counts did not change significantly after either prednisolone (− 0.8% ± 9.2%) or placebo (7.9% ± 7.9%) (P = 0.5). Although lamina propria T-lymphocyte counts decreased significantly after prednisolone (22.0% ± 5.6%, P = 0.003), but not after placebo (11.5% ± 8.6%, P = 0.1), this was not associated with any significant treatment-related improvement in abdominal pain, diarrhoea, frequency or urgency.
Conclusions : Prednisolone does not appear to reduce the number of enterochromaffin cells or cause an improvement in symptoms in post-infectious irritable bowel syndrome. Other approaches to this persistent condition are indicated.