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Irritable Bowel Syndrome

Recent and Novel Therapeutic Approaches

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Abstract

Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder affecting up to 3–15% of the general population in Western countries. It is characterised by unexplained abdominal pain, discomfort and bloating in association with altered bowel habits. The pathophysiology of IBS is considered to be multifactorial, involving disturbances of the brain-gut-axis: IBS has been associated with abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, autonomic dysfunction and mucosal inflammation. Traditional IBS therapy is mainly symptom oriented and often unsatisfactory. Hence, there is a need for new treatment strategies. Increasing knowledge of brain-gut physiology, mechanisms, and neurotransmitters and receptors involved in gastrointestinal motor and sensory function have led to the development of several new therapeutic approaches. This article provides a systematic overview of recently approved or novel medications that show promise for the treatment of IBS; classification is based on the physiological systems targeted by the medication. The article includes agents acting on the serotonin receptor or serotonin transporter system, novel selective anticholinergics, α-adrenergic agonists, opioid agents, cholecystokinin antagonists, neurokinin antagonists, somatostatin receptor agonists, neurotrophin-3, corticotropin releasing factor antagonists, chloride channel activators, guanylate cyclase-c agonists, melatonin and atypical benzodiazepines. Finally, the role of probiotics and antibacterials in the treatment of IBS is summarised.

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Acknowledgements

This article was supported in part by grants RO1-DK54681, RO1–DK67071 and K24-DK02638 (to Dr Camilleri) from the National Institutes of Health and by the Gerhardt Katsch Grant of the German Society of Digestive and Metabolic Diseases (Dr Andresen). The excellent secretarial support of Mrs Cindy Stanislav is gratefully acknowledged.

In relation to the content of this article, Dr Camilleri has served as a consultant to Novartis and GlaxoSmithKline, and has received research grants from Alizyme, Adolor, ARYx, Merck KGaA, Forest Laboratories, Sucampo, Microbia and VSL Pharmaceuticals to study pharmacodynamics of renzapride, alvimopan, ATI-5705, asimadoline, dexloxiglumide, lubiprostone, MD-1100 and VSL#3, respectively. Dr Andresen has served as a consultant to Solvay and Glaxo-SmithKline.

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  1. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) Program, Mayo Clinic College of Medicine, 200 First St, S.W., Rochester, Minnesota, 55905, USA

    Viola Andresen & Michael Camilleri

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  1. Viola Andresen
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  2. Michael Camilleri
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Correspondence to Viola Andresen.

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Andresen, V., Camilleri, M. Irritable Bowel Syndrome. Drugs 66, 1073–1088 (2006). https://doi.org/10.2165/00003495-200666080-00004

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