Skip to main content
SpringerLink
Log in

Postoperative colonic motility after tropisetron and a standardized meal in patients undergoing conventional colorectal surgery

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Early postoperative enteral nutrition is advantageous for the recovery of colonic motility but may be limited by abdominal distension, nausea, and vomiting. We aimed to investigate the tolerance of a standardized meal after pretreatment with the 5-hydroxytryptamine-3-receptor antagonist tropisetron and to study the concomitant colonic motility.

Methods

Colonic motility and tone were recorded on postoperative day 1 to 3 with a combined manometry/barostat recording catheter in 12 patients who underwent open colorectal surgery with an anastomosis in the distal colon or rectum. The study protocol consisted of 30 min of baseline recordings followed by 5 mg of tropisetron intravenously. Then, motility was recorded for another 30 min before patients ingested a standardized meal to trigger the gastrocolonic response. Postprandial motility was recorded for the subsequent 60 min.

Results

The colonic motility index increased after administration of tropisetron on all three postoperative days (day 1: 34±11 vs 122±48, day 2: 55±19 vs 101±25, and day 3: 42±16 vs 93±33 mmHg/min; p<0.05). No further increase of the motility index was observed postprandially. Frequency and amplitude of contractions were virtually unaffected by tropisetron and the meal. Barostat bag volume decreased postprandially in the proximal bag on the third, and in the distal bag on the first and second postoperative day (p<0.05). Patients’ condition was unaffected by the standardized meal after tropisetron administration.

Conclusions

Tropisetron may enhance colonic motility in the early postoperative period; however, the gastrocolonic response was impaired thereafter. High caloric food intake is well tolerated early after surgery after tropisetron pretreatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bisgaard T, Kehlet H (2002) Early oral feeding after elective abdominal surgery—what are the issues? Nutrition 18:944–948

    Article  PubMed  Google Scholar 

  2. Lewis SJ, Egger M, Sylvester PA, Thomas S (2001) Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 323:1–5

    Article  Google Scholar 

  3. Ortiz H, Armendariz P, Yarnoz C (1996) Is early postoperative feeding feasible in elective colon and rectal surgery? Int J Colorectal Dis 11:119–121

    Article  PubMed  CAS  Google Scholar 

  4. Hartsell PA, Frazee RC, Harrison JB, Smith RW (1997) Early postoperative feeding after elective colorectal surgery. Arch Surg 132:518–521

    PubMed  CAS  Google Scholar 

  5. Kasparek MS, Mueller MH, Glatzle J, Enck P, Becker HD, Zittel TT, Kreis ME (2004) Postoperative colonic motility increases following oral food intake in patients undergoing colorectal surgery. Surgery 136:1019–1027

    Article  PubMed  Google Scholar 

  6. Scolapio JS, Camilleri M, von der Ohe MR, Hanson RB (1995) Ascending colon response to feeding: evidence for a 5-hydroxytryptamine-3 mechanism. Scand J Gastroenterol 30:562–567

    PubMed  CAS  Google Scholar 

  7. von der Ohe MR, Hanson RB, Camilleri M (1995) Serotonergic mediation of postprandial colonic tonic and phasic responses in man. Gut 35:536–541

    Google Scholar 

  8. Boogaerts JG, Bardiau FM, Seidel L, Albert A, Ickx BE (2000) Tropisetron in the prevention of postoperative nausea and vomiting. J Clin Anesth 12:402–408

    Article  PubMed  CAS  Google Scholar 

  9. Kovac AL (2000) Prevention and treatment of postoperative nausea and vomiting. Drugs 59(2):213–243

    Article  PubMed  CAS  Google Scholar 

  10. Hesketh PJ (2000) Comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer Invest 18(2):163–173

    PubMed  CAS  Google Scholar 

  11. Kreis ME, Kasparek MS, Zittel TT, Becker HD, Jehle EC (2001) Neostigmine increases postoperative colonic motility in patients undergoing colorectal surgery. Surgery 130:449–456

    Article  PubMed  CAS  Google Scholar 

  12. Huge A, Kreis ME, Zittel TT, Becker HD, Starlinger MJ, Jehle EC (2000) Postoperative colonic motility and tone in patients following colorectal surgery. Dis Colon Rectum 43:932–939

    Article  PubMed  CAS  Google Scholar 

  13. Talley NJ (1992) Review article: 5-hydroxytryptamine agonists and antagonists in the modulation of gastrointestinal motility and sensation: clinical implications. Aliment Pharmacol Ther 6:273–289

    Article  PubMed  CAS  Google Scholar 

  14. Costall B, Naylor RJ (1990) Review: 5-hydroxytryptamine: new receptors and novel drugs for gastrointestinal motor disorders. Scand J Gastroenterol 25:769–787

    PubMed  CAS  Google Scholar 

  15. Meller ST, Lewis SJ, Brody MJ, Gebhart GF (1992) Vagal afferent-mediated inhibition of a nociceptive reflex by i.v. serotonin in the rat. II. Role of 5-HT receptor subtypes. Brain Res 585:71–86

    Article  PubMed  CAS  Google Scholar 

  16. Camilleri M (2002) Serotonergic modulation of visceral sensation: lower gut. Gut 51(Suppl I):i81–i86

    Article  PubMed  CAS  Google Scholar 

  17. Talley NJ, Phillips SF, Haddad A, Miller LJ, Twomey C, Zinsmeister AR et al (1990) GR 38032F (ondansetron), a selective 5-HT3 receptor antagonist, slows colonic transit in healthy man. Dig Dis Sci 35:477–80

    Article  PubMed  CAS  Google Scholar 

  18. Gore S, Gilmore IT, Haigh CG, Brownless SM, Stockdale H, Morris AI (1990) Colonic transit in man slowed by ondansetron (GR38032F), a selective 5-hydroxytryptamine receptor (type 3) antagonist. Aliment Pharmacol Ther 4:139–144

    Article  PubMed  CAS  Google Scholar 

  19. Hammer J, Phillips SF, Talley NJ, Camilleri M (1993) Effect of a 5HT3-antagonist (ondansetron) on rectal sensitivity and compliance in health and the irritable bowel syndrome. Aliment Pharmacol Ther 7:543–551

    Article  PubMed  CAS  Google Scholar 

  20. Camilleri M (2000) Pharmacology and clinical experience with alosetron. Expert Opin Investig Drugs 9:147–159

    Article  PubMed  CAS  Google Scholar 

  21. Clemens SHM, Samsom M, Van Berge Henegouwen GP, Fabri M, Smout AJPM (2002) Effect of alosetron on left colonic motility in non-constipated patients with irritable bowel syndrome and healthy volunteers. Aliment Pharmacol Ther 16:993–1002

    Article  PubMed  CAS  Google Scholar 

  22. Stacher G, Gaupmann G, Schneider C, Stacher-Janotta S, Steiner-Mittelbach G, Abatzi TA et al (1989) Effect of a 5-hydroxytryptamine-3 receptor antagonist (ICS 205–930) on colonic motor activity in healthy men. Br J Pharmacol 28:315–322

    CAS  Google Scholar 

  23. Kalff JC, Schwarz NT, Simmons RL, Bauer AJ (1998) Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in paralytic ileus. Ann Surg 228:652–663

    Article  PubMed  CAS  Google Scholar 

  24. Kalff JC, Carlos TM, Schraut WH, Billiar TR, Simmons RL, Bauer AJ (1999) Surgically induced leukocytic infiltrates within the rat intestinal muscularis mediate postoperative ileus. Gastroenterology 117:378–387

    Article  PubMed  CAS  Google Scholar 

  25. De Jonge WJ, The FO, Van der Coelen D, Bennink RJ, Reitsma PH, Van Deventer SJ, et al (2004) Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice. Gastroenterology 127:535–545

    Article  PubMed  Google Scholar 

  26. Williams RM, Berthoud HR, Stead RH (1997) Vagal afferent nerve fibres contact mast cells in rat small intestinal mucosa. Neuroimmunomodulation 4:266–270

    PubMed  CAS  Google Scholar 

  27. Castex N, Fioramonti J, Fargeas MJ, More J, Bueno L (1994) Role of 5-HT3 receptors and afferent fibres in the effects of mast cell degranulation on colonic motility in rats. Gastroenterology 107(4):976–984

    PubMed  CAS  Google Scholar 

  28. Bueno L, Fargeas MJ, Theodorou V, Fioramonti J (1991) Involvement of 5-hydroxytryptamine in the intestinal motor disturbances induced by mast cell degranulation in rats. Eur J Pharmacol 192(2):263–269

    Article  PubMed  CAS  Google Scholar 

  29. Lee CR, Plosker GL, McTavish D (1993) Tropisetron. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential as an antiemetic. Drugs 46(5):925–943

    PubMed  CAS  Google Scholar 

  30. Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD (1995) Is early oral feeding safe after elective colorectal surgery? A prospective randomized trail. Ann Surg 222:73–77

    Article  PubMed  CAS  Google Scholar 

  31. Björnsson ES, Chey WD, Ladabaum U, Woods ML, Hooper FG, Owyang C, et al (1998) Differential 5-HT3 mediation of human gastrocolonic response and colonic peristaltic reflex. Gastrointest Liver Physiol 38:G498–G505

    Google Scholar 

  32. De Ponti F, Tonini M (2001) Irritable bowel syndrome. New agents targeting serotonin receptor subtypes. Drugs 61:317–332

    Article  PubMed  Google Scholar 

  33. Waldhausen JHT, Shaffrey ME, Skenderis BS, Jones RS, Schirmer BD (1990) Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 211:777–785

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

The present study was supported by the DFG (Deutsche Forschungsgemeinschaft, KR 1816/1-1). It was completely investigator-driven without any support or involvement of the pharmaceutical industry.

Author information

Authors and Affiliations

  1. Department of General Surgery, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Straβe 3, Tuebingen, 72076, Germany

    Michael S. Kasparek, Joerg Glatzle, Andreas Vogt, Alfred Koenigsrainer & Tilman T. Zittel

  2. Department of Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, Muenchen, 81377, Germany

    Mario H. Mueller & Martin E. Kreis

Authors
  1. Michael S. Kasparek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joerg Glatzle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario H. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Vogt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alfred Koenigsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tilman T. Zittel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin E. Kreis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kasparek, M.S., Glatzle, J., Mueller, M.H. et al. Postoperative colonic motility after tropisetron and a standardized meal in patients undergoing conventional colorectal surgery. Int J Colorectal Dis 22, 521–529 (2007). https://doi.org/10.1007/s00384-006-0182-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-006-0182-x

Keywords

Search

Navigation