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We have previously shown that 5-HT may play a role in the post-prandial exacerbation of symptoms seen in female patients with d-lBS. As both progesterone (P) and oestrogen (O) can influence the 5-HT system, the aim of th s study was to compare plasma 5-HT concentrations in female patients with d-lBS (Rome II) with high and ow levels of P/O. Platelet depleted plasma (PDP) 5-HT concentration was therefore assessed for 2 h (60 min intervals) under fasting conditions and 4 h (30 min intervals) after a standard carbohydrate meal (457 kcal) in 39 patients (aged 19-52 yrs) with high P/O (studied either during the luteal phase of the menstrual cycle or while taking combined P/O oral contraception) and in 11 aged matched patients (aged 22-45 years) with Iow P/O levels (menses). 5-HT concentration was measured by reverse-phase high performance liquid chromatography with fluorimetric detection. In addition, symptomatology (0-4; 4 = severe) was assessed throughout the study. Results: Under fasting conditions there was no difference in PDP 5-HT concentration between patients with a high (5.41 ng/ml, (mean)) and Iow (4.98 ng/ml; difference high Iow (95%CI), 0.43 ng/ml (-0.69,1.55) ng/ml; p = 0.443) P/O status. Following meal ingestion, however, patients with high P/O levels have a significantly higher PDP 5-HT peak (13.99 ng/ml; (geometric mean) than those with Iow P/O levels (8.57 ng/ml; ratio high:low, 1.63 (1.02,2.62); p = 0.043). This difference was particularly evident in patients reporting post-prandial symptoms (patients with high P/O levels (n = 31): 15.60 ng/ml v patients with Iow P/O levels (n = 11): 8.57 ng/ml; ratio high:low, 1.82 (1.12, 2.96); p = 0.017) and was not related to a difference in symptom severity between the two groups (patients with high P/O levels: 0.70 (mean) v Iow P/E levels: 0.58; difference highIow, 0.12 (-0.28, 0.53); p = 0.547. Conclusions: Female sex hormones may play a role in the gastrointestinal tract 5-HT response to a meal in female... [ABSTRACT FROM AUTHOR]