Saslow S B, Scolapio J S, Camilleri M, Forstrom L A, Thomforde G M, Burton D D, Rubin J, Pitot H C, Zinsmeister A R
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gut. 1998 May;42(5):628-34. doi: 10.1136/gut.42.5.628.
Carcinoid diarrhoea is associated with rapid small bowel and proximal colonic transit. Intravenous administration of a serotonin type 3 receptor (5HT3) antagonist restores postprandial colonic tone towards normal in carcinoid patients.
To evaluate the medium-term effects of an oral 5HT3 antagonist, alosetron, on symptoms, stool fat, and transit in patients with carcinoid diarrhoea.
In 27 patients with carcinoid diarrhoea, symptoms were recorded daily and gastrointestinal transit was measured by scintigraphy in a three dose (0.1, 0.5, 2.0 mg, twice daily), randomised (1:1:1), parallel group, four week study. Placebo was given during the first week. Loperamide (2 mg capsules) was used as rescue medication.
There were numerical improvements in median diarrhoea score, stool weight, loperamide use, and overall colonic transit at four hours, but no overall significant drug effect was shown. Alosetron reduced the proximal colon emptying rate (p < 0.05 in 20 evaluable comparisons), but did not significantly alter small bowel transit.
Alosetron retardation of proximal colonic emptying in patients with carcinoid diarrhoea confirms the potential role of a 5HT3 mechanism in this disorder. Doses of alosetron higher than 2.0 mg twice daily will be required for symptomatic benefit in carcinoid diarrhoea.
类癌性腹泻与小肠和近端结肠快速转运有关。静脉注射5-羟色胺3型受体（5HT3）拮抗剂可使类癌患者餐后结肠张力恢复正常。
评估口服5HT3拮抗剂阿洛司琼对类癌性腹泻患者症状、粪便脂肪及转运的中期影响。
对27例类癌性腹泻患者进行为期四周的研究，研究采用三剂量（0.1、0.5、2.0mg，每日两次）、随机（1:1:1）、平行组设计，每天记录症状，并用闪烁扫描法测量胃肠转运。第一周给予安慰剂。洛哌丁胺（2mg胶囊）用作急救药物。
腹泻中位数评分、粪便重量、洛哌丁胺使用量及四小时时的结肠总体转运有数值上的改善，但未显示出总体显著的药物效果。阿洛司琼降低了近端结肠排空率（20次可评估比较中p<0.05），但未显著改变小肠转运。
阿洛司琼延缓类癌性腹泻患者近端结肠排空，证实了5HT3机制在该疾病中的潜在作用。类癌性腹泻患者若要获得症状改善，每天需服用高于2.0mg、每日两次剂量的阿洛司琼。
