Sacral Nerve Modulation Has No Effect on the Postprandial Response in Irritable Bowel Syndrome

Abstract

Purpose

Irritable bowel syndrome is a common gastrointestinal disorder with a global prevalence of approximately 11%. Onset or worsening of symptoms following digestion is one of the characteristics of the condition. The present study aimed at evaluating the postprandial sensory and motor response before and after treatment with sacral nerve modulation.

Patients and Methods

Twenty-one irritable bowel syndrome patients, 12 diarrhea-predominant and 9 mixed, were eligible for a 6-week sacral nerve modulation test period. Patients were investigated with multimodal impedance planimetry including a standardized meal at baseline and at the end of 2 weeks of suprasensory stimulation embedded in the 6-week sacral nerve modulation period.

Results

There was no statistical significant difference in the sensory response to heat or cold before and after sacral nerve modulation, p>0.05. At baseline, wall tension increased after the meal (mean 124.79 [range 82.5 to 237.3] mmHg.mm before the meal, mean 207.76 [range, 143.5 to 429] mmHg.mm after the meal), p=0.048 indicating a postprandial response. During sacral nerve modulation, the postprandial increase in wall tension did not reach statistical significance (mean 86.79 [range 28.8 to 204.5] mmHg.mm before the meal, mean 159.71 [range 71.3 to 270.8] mmHg.mm after the meal), p=0.277. However, there was no statistically significant difference between the postprandial wall tension at baseline and during sacral nerve modulation, p=0.489. Likewise, we found no difference between pressure or stretch ratio at baseline and during sacral nerve modulation, p>0.05.

Conclusion

Sacral nerve modulation does not exert its positive treatments effects in diarrhea-predominant and mixed irritable bowel syndrome through a modulation of the postprandial response.

Keywords:

• sacral nerve stimulation
• sacral nerve modulation
• postprandial response
• gastrocolic response
• irritable bowel syndrome

Abbreviations

CSA, Cross-sectional area; IBS-D, Diarrhea-predominant irritable bowel syndrome; GSRS-IBS, Gastrointestinal Symptom Rating Scale – Irritable Bowel Syndrome; IBS, Irritable Bowel Syndrome; IBS-M, Mixed irritable bowel syndrome; MPDT, Moderate pain detection threshold; PDT, Pain detection threshold; SNM, Sacral Nerve Modulation; VAS, Visual analog scale.

Data Sharing Statement

Data is available upon reasonable request attended to the corresponding author. There exists no additional unpublished data from the double-blinded, placebo-controlled crossover study.

Ethics Approval and Informed Consent

The study is approved the Danish Ethics Committee, ID1-10-72-170-13. All patients gave informed and written consent before enrollment in the study.

Author Contributions

All authors have contributed with the conception and design, data acquisition, or data analysis and interpretation, drafting the article or revising it for important intellectual content, approved the final version to be published and agrees to be accountable for all aspects of the work.

Disclosure

LL has previously received honoraria from Medtronic Inc. as speaker. SL has previously received an honorarium as a member of the Medtronic Inc. Medical Advisory Board. The authors report no other conflicts of interest in this work.

Additional information

Funding

Neurostimulators and leads were provided free of charge by Medtronic Inc. The company had no role in the study design, data collection, data analysis, interpretation of data, or writing of the manuscript. The Karen Elise Jensens Foundation (903959, Denmark) has financially supported Donghua Liao´s work.