Dietary and pharmacological treatment of abdominal pain in IBS

Gut. 2017 May;66(5):966-974. doi: 10.1136/gutjnl-2016-313425. Epub 2017 Feb 23.

Abstract

This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT3 receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT3 receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

Keywords: IRRITABLE BOWEL SYNDROME; VISCERAL SENSITIVITY.

Publication types

  • Review

MeSH terms

  • Abdominal Pain / diet therapy*
  • Abdominal Pain / drug therapy*
  • Abdominal Pain / etiology
  • Anti-Infective Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Butyrophenones / therapeutic use
  • Dipeptides / therapeutic use
  • GABA Agents / therapeutic use
  • Gastrointestinal Agents / therapeutic use
  • Histamine H1 Antagonists / therapeutic use
  • Humans
  • Imidazoles / therapeutic use
  • Irritable Bowel Syndrome / complications*
  • Parasympatholytics / therapeutic use
  • Phenylalanine / analogs & derivatives
  • Phenylalanine / therapeutic use
  • Piperidines / therapeutic use
  • Plant Oils / therapeutic use
  • Probiotics / therapeutic use
  • Quaternary Ammonium Compounds / therapeutic use
  • Rifamycins / therapeutic use
  • Rifaximin
  • Serotonin 5-HT3 Receptor Antagonists / therapeutic use
  • Thiophenes / therapeutic use
  • Visceral Pain / diet therapy*
  • Visceral Pain / drug therapy*
  • Visceral Pain / etiology
  • Visceral Pain / physiopathology

Substances

  • Anti-Infective Agents
  • Antidepressive Agents
  • Butyrophenones
  • Dipeptides
  • GABA Agents
  • Gastrointestinal Agents
  • Histamine H1 Antagonists
  • Imidazoles
  • Parasympatholytics
  • Piperidines
  • Plant Oils
  • Quaternary Ammonium Compounds
  • Rifamycins
  • Serotonin 5-HT3 Receptor Antagonists
  • Thiophenes
  • ibodutant
  • octylonium
  • eluxadoline
  • Phenylalanine
  • peppermint oil
  • Rifaximin
  • ebastine