Effect of Colonoscopy Premedication Containing Diazepam and Pethidine on the Release of Mast Cell Mediators in Gut Mucosal Samples

Abstract

Background and Study Aims: To date there is no information available on whether drugs that are commonly used in premedication for colonoscopy procedures, such as diazepam and pethidine, may activate intestinal mast cells and thereby give rise to adverse effects. Since opioids such as pethidine are well-known for their ability to induce histamine release from several mast cell subtypes, the present study investigated the effect of diazepam and pethidine, intravenously administered as premedication for colonoscopy, on mast cell mediator secretion from colonic and rectal mucosa.

Patients and Methods: The secretion of the mast cell mediators histamine and tryptase was followed from biopsies of patients with and without premedication for 30 minutes in an air-bubbled incubation medium (mucosa oxygenation). The mediator release and tissue histamine content were studied prospectively in 17 control persons (histologically normal mucosa) as well as in 71 patients with inflammatory bowel disease (IBD) (histologically uninvolved and involved tissue).

Results: Although a significant accumulation of histamine was found in inflamed IBD-tissue, the results indicate, however, that this premedication does not enhance the release of histamine or tryptase from gut mucosal samples, neither in the histologically normal mucosa of control persons nor in tissue unaffected or affected by inflammatory bowel disease.

Conclusion: This study demonstrates that colonoscopy premedication with diazepam and pethidine is safe in terms of gut mucosal mast cell activation.