Gastrointestinal Disorders

Irritable Bowel Syndrome

Chadda, Joshi and Chadda, Journal of the Association of Physicians in India (1983),2380 reported a randomized double-blind crossover trial of PHT (100 mg t.i.d.) versus placebo in twenty-five patients with irritable bowel syndrome. Seven had spastic colitis; eight, alternating diarrhea and constipation; and ten, mucous colitis. Twenty-two of the patients also suffered abdominal pain. Trials were for three weeks each, with a ten-day drug-free interval between crossover. Improvement was observed in twelve of the patients while on PHT. Five improved in the placebo group.

2380. Chadda, V. S., Joshi, K. G., Chadda, S., A double-blind crossover study of diphenylhydantoin in irritable bowel syndrome, J. Assoc. Physicians India, 31 (7): 425-7, 1983.

De La Torre, Navarro and Aldrete, Current Therapeutic Research (1985),2437 compared PHT with conventional treatment in a study of eighty patients with irritable bowel syndrome. Forty patients received PHT, 100 mg t.i.d., and forty patients received an anticholinergic, an antacid, and either a tranquilizer or an antidepressant. With PHT, thirty of the forty patients had an excellent to satisfactory response, compared to eighteen in the group that received conventional treatment.

 Abdominal pain, diarrhea, constipation, nausea, vomiting and pyrosis were among the symptoms that responded. In addition, PHT treatment resulted in a statistically significant greater number of complete remissions of depression, insomnia and anxiety.

2437. de la Torre, R., Navarro, J. L., Aldrete, J. A., Comparison between phenytoin and conventional treatment for irritable bowel syndrome, Curr. Ther. Res., 38(4): 661-9, 1985.

Ulcerative Colitis 

Schaerrer, Personal Communication (1963),2927 reported observations of forty-six patients with chronic idiopathic ulcerative colitis. Nineteen patients responded to treatment with PHT, 150-300 mg/day. Patients were classified as responding only if they remained symptom-free for a period of at least one year. All patients responding to PHT returned to normal or near-normal bowel habits, had a normal mucosal pattern, and gained weight.

2927. Schaerrer, W. C., The use of Dilantin in the treatment of chronic ulcerative colitis, Personal Communication, 1-3, 1963.

Diabetic Neuropathy

Ellenberg, New York State Journal of Medicine (1968),431 recognized the urgent need for a beneficial therapeutic agent in diabetic neuropathy and stated that this need was underscored by the frequent use of narcotics to control the severe pain, with the ever-present threat of addiction. The author noted that PHT was not addictive, did not sedate and, on the assumption that the symptoms of diabetic neuropathy might have a similar background to tic douloureux in which PHT was used with success, a therapeutic trial was undertaken.

PHT was used to treat painful diabetic peripheral neuropathy in sixty patients. Based on symptomatic relief of pain and paresthesias, excellent results were obtained in forty-one patients and fair response in ten patients. Improvement was noted in from twenty-four to ninety-six hours. As a feature of control, when the drug was discontinued, symptoms frequently recurred. A salutary response was uniformly repeated on reinstitution of PHT.

In two of the sixty cases skin rash occurred, one associated with fever. These reactions disappeared upon withdrawal of the medicine.

Nine years later, in JAMA,1819 Ellenberg repeated his recommendation of the use of PHT in the treatment of painful diabetic neuropathy, eliminating the use of narcotics.

431. Ellenberg, M., Treatment of diabetic neuropathy with diphenylhydantoin, New York J. Med., 68: 2653-2655, 1968.
1819. Ellenberg, M., Unremitting painful diabetic neuropathy, JAMA, 237(18): 1986, 1977.

Kannan, Dash and Rastogi, Journal of Diabetic Association of India (1978),1920 in a double-blind crossover study of sixteen patients with diabetic neuropathy, found that thirteen had significant relief of pain and/or paresthesias with 100 mg PHT t.i.d.

1920. Kannan, K., Dash, R. J. and Rastogi, G. K., Evaluation of treatment of painful diabetic neuropathy with diphenylhydantoin, J. Diabetic Assoc. India, 18; 199-202, 1978.

Chadda and Mathur, Journal of the Association of Physicians in India (1978),1767 in a double-blind study with PHT found significant improvement in pain and paresthesias in twenty-eight of thirty-eight patients with diabetic neuropathy.

The authors conclude that PHT is an effective and well-tolerated drug for the relief of pain in diabetic neuropathy, and is preferred to narcotics.

1767. Chadda, V. S. and Mathur, M. S., Double blind study of the effects of diphenylhydantoin sodium on diabetic neuropathy, J. Assoc. Phys. Ind., 26: 403-6, 1978.

See also Clinical Uses: Treatment of Pain.

See also Ref.

3349. Anonymous, Diarrhea in the diabetic patient and phenytoin, Bol. Hosp. Juan de Dios, 33(5): 311, 1986.