Sensory adaptation training or escitalopram for ibswith constipation and rectal hypersensitivity: A randomized controlled trial

INTRODUCTION: Rectal hypersensitivity is an important pathophysiological dysfunction in irritable bowel syndrome with predominant constipation (IBS-C), whose treatment remains challenging. In a randomized controlled trial, we compared the efficacy and safety of a novel sensori-behavioral treatment, sensory adaptation training (SAT) with escitalopram. METHODS: Patients with IBS-C (Rome III) with rectal hypersensitivity received6 biweekly sessions of SAT or escitalopram 10mgdaily for 3months. 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. Coprimary outcome measures were those achieving improvements in rectal hypersensitivity ( 20% increase in 2/3 sensory thresholds) and pain ( 30% decrease). RESULTS: Werandomized 49 patients; 26 received SAT and23 escitalopram. SAT significantly improved desire to defecate (D 13.562.3 vs 2.261.1mmHg, P50.0006) and maximum tolerability (D 14.861.9 vs 1.6 6 0.9 mm Hg, P < 0.0001) thresholds compared with escitalopram. There were significantly greater percentage of hypersensitivity responders with SAT than escitalopram (69% vs 17%, P < 0.001), but not pain responders (58%vs44%, P50.4). Daily pain scores did not differ between groups (P 5 0.8) or escitalopram (P 5 0.06) but decreased with SAT (P 5 0.0046) compared with baseline. SAT significantly increased rectal compliance (P < 0.019) and complete spontaneous bowel movements per week than escitalopram (P 5 0.04). Five withdrew from adverse events with escitalopram and none with SAT. DISCUSSION: 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.