New Pharmaceutical Approaches to the Treatment of IBS:Future Development & Research

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Annals of Gastroenterology
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2007 (EN)
New Pharmaceutical Approaches to the Treatment of IBS:Future Development & Research (EN)

R. Spiller, N. Coleman,

SUMMARY Current approaches to treatment of Irritable Bowel Syndrome (IBS) aim to normalise disturbed intestinal physiology. The most effective centrally acting drugs are tricyclic antidepressants. Alosetron, a 5-HT3 receptor antagonist is effective in women with diarrhea-predominant IBS whilst tegaserod and prucalopride are 5-HT4 agonists enhancing bowel motility in constipation-predominant IBS. Serotonergic receptor modulation has been the first targeted pharmacological intervention. The development of new drugs constitutes a major challenge as there are many targets along the brain-gut axis and the enteric nervous system (ENS). Newer tricyclic antidepressants with fewer side effects and corticotrophin releasing factor-1 (CRF-1) antagonists are examples of future centrally acting drugs. Agents that alter visceral sensitivity include kappa-opioid agonists (fedotozine, trimebutine, asimadoline), alpha-2 adrenoreceptor agonists (clonidine, lidamidine), tachykinin receptor antagonists (neurokinin A, substance P) and other experimental anti-nociceptive drugs (GABA-B receptor agonists). COX-2 inhibitors may be effective for postinfectious IBS. Drugs potentially useful in controlling intestinal motility and secretion other than serotonergic receptors modulators, include muscarinic receptors antagonists (derifenacin, zamenifenacin), octreotide and CCK-1 receptor antagonists (dexloglumide). Neurotrophins (NT- 3 and brain derived neurotrophic factor) are promising factors for the treatment of IBS patients with constipation. The development of new and effective drugs for IBS requires a more detailed understanding of pathophysiologic mechanisms, a fact that will allow us a more targeted intervention. Key words: Irritable bavel syndrome, visceral sensitivity tricyclic antidepressants, muscarinic receptors (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 15, No 3 (2002) (EN)

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