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Melatonin Effective in Relieving Pain But Not Sleep Disturbance Related to Irritable Bowel Syndrome: Presented at UEGW

By Chris Berrie

PRAGUE, CZECH REPUBLIC -- September 30, 2004 -- Despite the absence of improvements in sleep disturbance and psychological stress, melatonin administration significantly attenuates abdominal pain and reduces rectal urgency and pain sensitivity in patients with irritable bowel syndrome (IBS) with sleep disturbance, according to a study presented here September 29th at the 12th United European Gastroenterology Week.

"Sleep disturbance is commonly observed in IBS patients, and the reported prevalence among IBS patients varies from 26% to 55%," said Lawrence K.Y. Ho, MD, associate professor, medicine, University of Singapore, Singapore, who was principal investigator for the randomised, double-blind, placebo-controlled study.

The pineal gland neurohormone melatonin is derived from serotonin (5-HT), which itself has been implicated in motility and pain perception in the intestinal system. In addition, melatonin is known to be a sleep-promoting agent. Dr. Ho and colleagues therefore sought to determine whether melatonin might be useful in relieving IBS symptoms and in improving rectal sensitivity, while exploring the effectiveness of melatonin in treating IBS-related sleep disturbance.

Forty patients diagnosed with IBS with sleep disturbance, according to the Rome II criteria, completed a series of questionnaires (eg, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale). They also underwent rectal-sensitivity testing with a pressurised balloon (graded as the following: "feel", "defecate," "urgent", "pain") and took part in a home, overnight polysomnography test.

Twenty patients were randomly assigned to receive melatonin 3 mg per night and 20 patients received placebo 1 tablet per night for a 2-week period, after which the 3-part assessment was repeated. There were no significant differences in the full range of patient characteristics at baseline between the two treatment groups.

At the assessment stage, reductions in the various abdominal symptom scores were compared between the two groups. The melatonin group had a significantly greater reduction in mean abdominal pain score (2.35) than the placebo group (0.70; P <.001). There was also a tendency towards a greater reduction in abdominal extension scores (1.05, 0.15, respectively, P =.069).

A significant effect within the melatonin group was seen with the sensory thresholds to rectal distension—both the urgency (P =.007) and pain thresholds for rectal distension (P =.003) were increased after the melatonin treatment.

However, there were no significant differences associated with changes in any of the categories within the subjective sleep scores or the objective sleep scores. Similarly, there were no significant differences between the melatonin- and placebo-associated changes in the anxiety and depression scores.

Dr. Ho and colleagues concluded that in the absence of improvements in sleep disturbance and psychological stress, the beneficial effects of melatonin on bowel symptoms and visceral sensitivity in IBS patients are independent of its action on sleep patterns and psychological profiles.


[Presentation title: "Melatonin Improves Bowel Symptoms in Irritable Bowel Syndrome Patients Who Have Sleep Disturbances—a Randomised, Double-Blind, Placebo-Controlled Study. Abstract OP-G-328." Abstract 483]

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