New and Investigational Agents for Irritable Bowel Syndrome

Wadhwa, Akhilesh; Camilleri, Michael; Grover, Madhusudan

doi:10.1007/s11894-015-0473-x

Cited by 9 publications

(5 citation statements)

References 72 publications

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“…Over the past 2 decades, clinical trials of investigational agents for IBS have focused on the treatment of specific symptoms. In the future, more specific therapies should become available, as our understanding of the complex, multidimensional pathophysiologic mechanisms involved in IBS advances, such as the role of altered epithelial barrier, secretion, bile acid metabolism, neurohormonal regulation, intestinal immune function, gut microbiota, and brain-gut regulation, among others [Wadhwa et al 2015]. Furthermore, while extremely challenging, investigating combinations of treatments in clinical trials of IBS-D would shed more light on this complex disorder, particularly as in 'real-world' clinical practice, combination treatments, such as those described in the clinical scenarios in this manuscript, are commonly utilized for patients with IBS-D.…”

Section: Discussionmentioning

confidence: 99%

Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice

Lucak

Chang

Halpert

et al. 2016

Therap Adv Gastroenterol

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Diagnosis of IBS is based on clinical symptom criteria and the exclusion of certain organic diseases only in patients presenting with concerning features [Chey et al. 2015b]. The recently released Rome IV diagnostic criteria for IBS are: recurrent Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice Susan Lucak, Lin Chang, Albena Halpert and Lucinda A. Harris Abstract: Irritable bowel syndrome with diarrhea (IBS-D) is a common, chronic functional gastrointestinal disorder with symptoms that can be distressing for patients and often result in substantially impaired quality of life. This review focuses on providing clinicians with information on practical, evidence-based treatment for IBS-D. Current therapies commonly used for the treatment of IBS-D, including pharmacologic and nonpharmacologic interventions, are briefly reviewed, followed by discussion of the emergent pharmacologic treatments (rifaximin and eluxadoline) and medical foods (IBgard ® and EnteraGam ® ). Given the lack of a standard treatment algorithm for IBS-D and the emergence of new pharmacologic therapies, treatment needs to be tailored to the individual patient and take into account the severity of disease. In this context, the latter part of this manuscript examines how treatments for IBS-D can be used in clinical practice by presenting three patient case scenarios with varying degrees of IBS-D severity. For each case, the patient's medical history and clinical presentation are related to the Rome Foundation multidimensional clinical profile (MDCP) and potential treatment options with current and emergent therapies are reviewed. The interplay of gastrointestinal symptoms and their psychosocial impact, as well as the importance of a patient-centered approach to therapy, are discussed. Consideration is given to the potential need for combination therapies and how emergent treatments could fit into the treatment pathway for mild, moderate, and severe cases of IBS-D in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice

Lucak

Chang

Halpert

et al. 2016

Therap Adv Gastroenterol

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“…Current therapeutic options for IBS are restricted to symptomatic treatment leaving visceral hypersensitivity untreated. Although there is some evidence for improvement with antidiarrheals, antispasmodics, bulking agents, laxatives, tricyclic antidepressants, and behavioral therapy, we will only highlight therapies targeting peripheral neuroimmune dysfunction.…”

Section: Current Therapiesmentioning

confidence: 99%

Neuroimmune factors in functional gastrointestinal disorders: A focus on irritable bowel syndrome

Boeckxstaens

Wouters

2016

Neurogastroenterology Motil

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This review discusses the potential mechanisms underlying aberrant neuroimmune interactions in peripheral sensitization of sensory nerves. A better understanding of the cells, mediators, and molecular mechanisms triggering persistent aberrant neuroimmune interactions brings new insights into their contribution to the physiology and pathophysiology of visceral pain perception and provides novel opportunities for more efficient therapeutic treatments for these disorders.

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“…Bile acids are thought to play a role in the pathogenesis of IBS as a subset of patients with diarrhea-predominant IBS have an increase in colonic bile acids and can be treated with bile acid sequestrants ( Wadhwa et al, 2015 ). Bile acids are traditionally associated with their role in lipid absorption.…”

Section: Introductionmentioning

confidence: 99%

Metabolomics: The Key to Unraveling the Role of the Microbiome in Visceral Pain Neurotransmission

et al. 2022

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Inflammatory bowel disease (IBD), comprising Crohn’s disease and Ulcerative colitis, is a relapsing and remitting disease of the gastrointestinal tract, presenting with chronic inflammation, ulceration, gastrointestinal bleeding, and abdominal pain. Up to 80% of patients suffering from IBD experience acute pain, which dissipates when the underlying inflammation and tissue damage resolves. However, despite achieving endoscopic remission with no signs of ongoing intestinal inflammation or damage, 30–50% of IBD patients in remission experience chronic abdominal pain, suggesting altered sensory neuronal processing in this disorder. Furthermore, effective treatment for chronic pain is limited such that 5–25% of IBD outpatients are treated with narcotics, with associated morbidity and mortality. IBD patients commonly present with substantial alterations to the microbial community structure within the gastrointestinal tract, known as dysbiosis. The same is also true in irritable bowel syndrome (IBS), a chronic disorder characterized by altered bowel habits and abdominal pain, in the absence of inflammation. An emerging body of literature suggests that the gut microbiome plays an important role in visceral hypersensitivity. Specific microbial metabolites have an intimate relationship with host receptors that are highly expressed on host cell and neurons, suggesting that microbial metabolites play a key role in visceral hypersensitivity. In this review, we will discuss the techniques used to analysis the metabolome, current potential metabolite targets for visceral hypersensitivity, and discuss the current literature that evaluates the role of the post-inflammatory microbiota and metabolites in visceral hypersensitivity.

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New and Investigational Agents for Irritable Bowel Syndrome

Cited by 9 publications

References 72 publications

Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice

Current and emergent pharmacologic treatments for irritable bowel syndrome with diarrhea: evidence-based treatment in practice

Neuroimmune factors in functional gastrointestinal disorders: A focus on irritable bowel syndrome

Metabolomics: The Key to Unraveling the Role of the Microbiome in Visceral Pain Neurotransmission

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