Pharmacological Treatment of the Irritable Bowel Syndrome and Other Functional Bowel Disorders

Abstract

Functional digestive disorders constitute one of the main causes of consultation in gastroenterology and primary health care. Is still unclear whether therapy has to be aimed to the gut, to the neural pathways controlling bowel motility and perception, or to the processing mechanisms of symptoms and disease behaviour. It is conceivable that in the next future better understanding of functional bowel disorders pathophysiology will help us to tailor treatment for different patients. At the moment, subclassification of the diverse patterns of symptomatology allows to adjust new treatments for irritable bowel syndrome (IBS) according to the clinical predominance for each patient. The knowledge of motor and sensorial response to different stimuli in IBS patients and the pathways to the central nervous system is an important source of information for the development of new molecules. Fiber-enriched diet is frequently given for constipation-predominant IBS. Loperamide, antispasmodic drugs and tricyclic antidepressants are nowadays the basis for pharmacological treatment of diarrhea- predominant IBS. The scientific evidence supporting this therapeutical approach is however limited. Visceral analgesics and serotonin agonists and antagonists may play an important therapeutical role in the near future. However, it is not likely that one single treatment will help every functional bowel disorder patient and many of them will need a more complex approach with a multidisciplinary therapy (diet, psychotherapy, medications).

Inhibition of Phosphodiesterase Type 4 Decreases Stress-Induced Defecation in Rats and Mice

“…An agent that deceases gut transit by relaxing smooth muscle/interfering with propulsive gut nervous contractions but with minimal gut secretory activity, like roflumilast, may be most ideal for IBS treatment. Considering that the majority of IBS sufferers alternate between diarrhea and constipation [44] , the therapeutic impact of PDE4 inhibition provides for its use during either alternating diarrhea or constipation symptoms, while loperamide can only be indicated for diarrhea type of IBS [45] . Also, loperamide can be contraindicated due to its effects to decrease secretion during constipation symptoms and due to its actions to increase gut contractions in individuals with heightened sensitivity to visceral/gut pain [43,46,47] .…”

Pilot study: a randomised, double blind, placebo controlled trial of pancrealipase for the treatment of postprandial irritable bowel syndrome-diarrhoea

“…Mainstream treatment recommendations for IBS-D, other than dietary modifications, have predominantly been antidiarrhoeal agents such as loperamide and diphenoxylate, tricyclic antidepressants or alosetron, a 5HT 3 receptor antagonist 7 16–18. Other possible therapies have included clonidine,19 cholestyramine,18 Chinese herbal therapy,20 21 cromolyn22 23 and psychotherapy 24 25.…”

“…Other possible therapies have included clonidine,19 cholestyramine,18 Chinese herbal therapy,20 21 cromolyn22 23 and psychotherapy 24 25. Antispasmodic agents such as hyoscyamine and dicyclomine are often prescribed but have not been established to be beneficial and may lose any possible benefit over time 7.…”

Trastornos funcionales digestivos post-infecciosos: del episodio agudo a la molestia crónica

“…Cuando los síntomas son más intensos es necesaria la utilización de fármacos dirigidos específicamente a aliviar sus molestias. Cuando los síntomas son aún más intensos, o incluso incapacitantes, es necesario el manejo por centros especializados para la utilización de medidas y de estudios especiales 6 .…”