4.2 Review

Pharmacotherapy for gastric and intestinal cramping pain: current and emerging therapies

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Review Pharmacology & Pharmacy

An update on the use of pharmacotherapy for opioid-induced bowel dysfunction

Taraneh Mousavi et al.

Summary: With the rise in aging population and chronic diseases, the use and abuse of opioids have increased worldwide, leading to an increase in opioid-related adverse events, specifically opioid-induced bowel dysfunction. This calls for a rational clinical management strategy.

EXPERT OPINION ON PHARMACOTHERAPY (2023)

Article Neurosciences

Increased GABAergic projections in the paraventricular nucleus regulate colonic hypersensitivity via oxytocin in a rat model of irritable bowel syndrome

Junshu Li et al.

Summary: The study aims to investigate the effects of adaptive changes induced by stress on IBS-like syndromes in rats. The results show that in rats with stress-induced IBS, there are more GABAergic projections in the paraventricular nucleus of the hypothalamus, which inhibit the firing rate of neurons and decrease oxytocin expression. Exogenous oxytocin improves gut motility and decreases abdominal withdrawal reflex scores. This suggests that the adaptive GABAergic projection in the paraventricular nucleus may be an important mediator of IBS, indicating a potential novel therapeutic target.

NEUROREPORT (2023)

Review Gastroenterology & Hepatology

Hyoscine butylbromide mode of action on bowel motility: From pharmacology to clinical practice

Maura Corsetti et al.

Summary: This review aims to provide an updated overview of the mechanisms of action of HBB and its clinical efficacy to guide clinical practice and future research.

NEUROGASTROENTEROLOGY AND MOTILITY (2023)

Article Neurosciences

Centrally administered GLP-1 analogue improves intestinal barrier function through the brain orexin and the vagal pathway in rats

Takuya Funayama et al.

Summary: Recent studies have shown that leaky gut is associated with various diseases and that orexin in the brain can block it in rats, suggesting a role of the brain in regulating intestinal barrier function. This study aimed to investigate the role of GLP-1 in the brain in regulating intestinal barrier function and the underlying mechanism. The results suggest that GLP-1 acts centrally in the brain to reduce colonic hyperpermeability through brain orexin signaling and the vagal cholinergic pathway.

BRAIN RESEARCH (2023)

Article Gastroenterology & Hepatology

Irritable bowel syndrome: treatment based on pathophysiology and biomarkers

Michael Camilleri et al.

Summary: This article evaluates the evidence that targeted pathophysiological mechanisms and customized treatments can be an alternative approach to treating patients with irritable bowel syndrome (IBS). The authors conducted a literature review on the mechanisms and treatments of IBS, identifying various noninvasive clinical tests that can assess the underlying mechanisms responsible for symptom generation. These mechanisms include rectal evacuation disorders, abnormal transit, visceral hypersensitivity or hypervigilance, bile acid diarrhea, sugar intolerances, barrier dysfunction, the microbiome, immune activation, and chemicals released by these mechanisms. The authors also recognized the basic molecular mechanisms contributing to these pathophysiologies, offering opportunities for interventions with medications targeted at specific food components, receptors, and potentially the microbiome. Although the evidence supporting interventions for each mechanism varies, the current state-of-the-art allows for a shift from symptom-based treatment to individualized treatment guided by pathophysiology and clinically identified biomarkers.
Article Multidisciplinary Sciences

Postprandial effect of gastrointestinal hormones and gastric activity in patients with irritable bowel syndrome

Agata Furgala et al.

Summary: This study aimed to assess the postprandial response, including gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant irritable bowel syndrome (IBS-C). The results showed that IBS-C patients had significantly elevated preprandial levels of gastrin and insulin, while VIP and ghrelin levels were decreased. Moreover, the gastric motility was impaired in IBS-C patients. These findings suggest that disturbances in the postprandial concentration of gut peptides may contribute to abnormal gastric function and intestinal motility, leading to exacerbation of clinical symptoms in IBS patients.

SCIENTIFIC REPORTS (2023)

Review Gastroenterology & Hepatology

Chronic Abdominal Pain: Gastroenterologist Approach

Snezana Lukic et al.

Summary: Abdominal pain can manifest differently depending on the underlying gastrointestinal disease, with varying locations, intensities, and patterns of radiation. Managing abdominal pain presents a significant challenge for gastroenterologists.

DIGESTIVE DISEASES (2022)

Review Medicine, General & Internal

The Efficacy of Mebeverine in the Treatment of Irritable Bowel Syndrome-A Systematic Review

Jaroslaw Daniluk et al.

Summary: Mebeverine has shown significant efficacy in treating irritable bowel syndrome, particularly in reducing abdominal pain and improving related symptoms. It has a good safety profile with minimal adverse effects.

JOURNAL OF CLINICAL MEDICINE (2022)

Article Biochemistry & Molecular Biology

Ghrelin polymorphism/TRPV1 receptor expression in Egyptian IBS patients

Walaa Samy et al.

Summary: This study found an association between ghrelin gene polymorphism and irritable bowel syndrome (IBS), with the GG genotype of rs696217 occurring more frequently in patients. This genotype was associated with a significant decrease in ghrelin mRNA expression and a subsequent increase in TRPV1 gene expression, which may explain some of the manifestations of IBS.

CYTOKINE (2022)

Review Gastroenterology & Hepatology

Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome

Maria Rosa Ingrosso et al.

Summary: This study aimed to evaluate the efficacy and safety of peppermint oil in the treatment of IBS. The results showed that peppermint oil was more effective than placebo, but adverse events occurred more frequently.

ALIMENTARY PHARMACOLOGY & THERAPEUTICS (2022)

Review Gastroenterology & Hepatology

Functional Abdominal Cramping Pain Expert Practical Guidance

Stefan Mueller-Lissner et al.

Summary: This article aims to present a working definition of Functional Abdominal Cramping Pain (FACP) and provide practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients. Based on expert consensus, the key features and treatment principles of FACP were clarified, and an algorithm was proposed to assist physicians in reaching a meaningful diagnostic endpoint.

JOURNAL OF CLINICAL GASTROENTEROLOGY (2022)

Article Psychology, Biological

Oxytocin acts centrally in the brain to improve leaky gut through the vagus nerve and a cannabinoid signaling in rats

Toshikatsu Okumura et al.

Summary: Brain oxytocin plays an important role in regulating intestinal barrier function. It can reduce colonic hyperpermeability and this effect is mediated by the vagal cholinergic pathway or cannabinoid 1 receptor signaling. This finding suggests that activation of central oxytocin signaling may be beneficial for the treatment of leaky gut-related diseases such as irritable bowel syndrome and autism.

PHYSIOLOGY & BEHAVIOR (2022)

Article Gastroenterology & Hepatology

Combination of a Probiotic and an Antispasmodic Increases Quality of Life and Reduces Symptoms in Patients with Irritable Bowel Syndrome: A Pilot Study

Diego A. Barraza-Ortiz et al.

Summary: The study showed that the use of the i3.1 probiotic formulation for treating IBS patients is consistent with previous research, and adding an antispasmodic can further enhance its effects.

DIGESTIVE DISEASES (2021)

Article Medicine, General & Internal

Buspirone in the management of refractory irritable bowel syndrome A case report

Mustafa Abdul Karim et al.

Summary: This case study suggests that buspirone is effective in treating refractory IBS. Further research is needed to evaluate the role of buspirone in IBS management.

MEDICINE (2021)

Review Endocrinology & Metabolism

Central regulatory mechanisms of visceral sensation in response to colonic distension with special reference to brain orexin

Toshikatsu Okumura et al.

Summary: Visceral hypersensitivity is a major factor in IBS, with recent data showing that neuropeptides in the brain play a crucial role in controlling visceral sensation. Various substances in the brain and central nervous system have been found to influence visceral sensitivity and pain relief through different mechanisms.

NEUROPEPTIDES (2021)

Article Gastroenterology & Hepatology

Peppermint Oil Treatment for Irritable Bowel Syndrome: A Randomized Placebo-Controlled Trial

Judy Nee et al.

Summary: This study compared the effects of peppermint oil vs placebo in relieving IBS symptoms and found both groups showed clinically meaningful improvement, but there were no significant differences between them. Further large, rigorous trials are needed to evaluate the role of peppermint oil for treating IBS.

AMERICAN JOURNAL OF GASTROENTEROLOGY (2021)

Review Gastroenterology & Hepatology

AGA Clinical Practice Update on Management of Chronic Gastrointestinal Pain in Disorders of Gut-Brain Interaction: Expert Review

Laurie Keefer et al.

Summary: Effective management of persistent pain in disorders of gut-brain interaction requires a collaborative, empathic, culturally sensitive, patient-provider relationship; providers should master patient-friendly language about the pathogenesis of pain and understand the psychological contexts in which pain is perpetuated; nonpharmacologic therapies should be routinely considered as part of comprehensive pain management and brought up early on in care.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2021)

Review Pediatrics

Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review

Robyn Rexwinkel et al.

Summary: Based on the current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment.

PEDIATRICS (2021)

Article Multidisciplinary Sciences

Pharmacological treatments of Chinese herbal medicine for irritable bowel syndrome in adults: A network meta-analysis of randomized controlled trials

Yun-bo Wu et al.

Summary: This study analyzed the therapeutic effect and safety of Chinese herbal medicine (CHM) in treating irritable bowel syndrome (IBS) compared to conventional therapies and placebo through a network meta-analysis. Some CHM therapies showed significant improvements in symptom relief and were more effective for certain symptoms. The quality of evidence based on the GRADE system was considered low.

PLOS ONE (2021)

Review Medicine, General & Internal

Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain-A Practical Review

Magdalena Janczura et al.

Summary: This review discusses the common disease entities where combinations of NSAIDs and spasmolytic drugs are used to reduce pain, emphasizing the benefits of fixed-dose combination products (FDCs) and their impact on efficacy and medical adherence. It also highlights the importance of developing FDCs based on valid therapeutic principles and considering the safety profile of all active substances in the product.

JOURNAL OF CLINICAL MEDICINE (2021)

Review Gastroenterology & Hepatology

Bile acid diarrhoea: pathophysiology, diagnosis and management

Alexia Farrugia et al.

Summary: The actual incidence of bile acid diarrhoea (BAD) is unknown, but evidences show it could be misdiagnosed as irritable bowel syndrome in up to 30% patients. BAD can be caused by various factors including cholecystectomy, infectious diarrhoea, and pelvic chemoradiotherapy. The interruption of negative feedback loops related to the enterohepatic circulation is believed to lead to BAD, which can greatly impact patient's quality of life.

FRONTLINE GASTROENTEROLOGY (2021)

Review Gastroenterology & Hepatology

Efficacy of pinaverium bromide in the treatment of irritable bowel syndrome: a systematic review and meta-analysis

Serhat Bor et al.

Summary: Pinaverium is more effective than placebo in treating IBS symptoms, with a significant relief in overall IBS symptoms, as well as positive effects on abdominal pain, stool changes, and bloating. The study results suggest that regardless of patient age or gender, study publication year, sample size, or methodological quality score, pinaverium demonstrates consistent efficacy in IBS treatment.

THERAPEUTIC ADVANCES IN GASTROENTEROLOGY (2021)

Article Gastroenterology & Hepatology

Comparative evaluation of efficacy and safety of drotaverine versus mebeverine in irritable bowel syndrome: A randomized double-blind controlled study

Ramesh R. Rai et al.

Summary: The study found that Drotaverine was significantly more effective than Mebeverine in improving pain severity, frequency, and stool-related symptoms in patients with irritable bowel syndrome.

SAUDI JOURNAL OF GASTROENTEROLOGY (2021)

Article Integrative & Complementary Medicine

Efficacy of a curcumin extract (Curcugen™) on gastrointestinal symptoms and intestinal microbiota in adults with self-reported digestive complaints: a randomised, double-blind, placebo-controlled study

Adrian L. Lopresti et al.

Summary: The study found that administering 500mg of Curcugen (TM) curcumin extract daily for 8 weeks significantly improved self-reported digestive complaints and anxiety levels. However, curcumin did not have a significant effect on intestinal microbiota or SIBO. Further research with larger samples and more detailed microbial analyses is needed.

BMC COMPLEMENTARY MEDICINE AND THERAPIES (2021)

Article Gastroenterology & Hepatology

Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome

Zsa Zsa R. M. Weerts et al.

GASTROENTEROLOGY (2020)

Article Neurosciences

Brain orexin improves intestinal barrier function via the vagal cholinergic pathway

Toshikatsu Okumura et al.

NEUROSCIENCE LETTERS (2020)

Review Pediatrics

Functional abdominal pain: what clinicians need to know

Edward Thomas Andrews et al.

ARCHIVES OF DISEASE IN CHILDHOOD (2020)

Review Biochemistry & Molecular Biology

An update on efficacy and safety considerations for the latest drugs used to treat irritable bowel syndrome

Taraneh Mousavi et al.

EXPERT OPINION ON DRUG METABOLISM & TOXICOLOGY (2020)

Article Medicine, General & Internal

Gastrointestinal pain

Asbjorn M. Drewes et al.

NATURE REVIEWS DISEASE PRIMERS (2020)

Review Gastroenterology & Hepatology

Global burden of irritable bowel syndrome: trends, predictions and risk factors

Christopher J. Black et al.

NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY (2020)

Article Medicine, General & Internal

Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial

Naveen Poonai et al.

CANADIAN MEDICAL ASSOCIATION JOURNAL (2020)

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How can we develop better antispasmodics for irritable bowel syndrome?

Sheyda Ranjbar et al.

EXPERT OPINION ON DRUG DISCOVERY (2019)

Article Gastroenterology & Hepatology

Guanylate cyclase-C as a therapeutic target in gastrointestinal disorders

Scott A. Waldman et al.

Article Gastroenterology & Hepatology

Relationship between irritable bowel syndrome and plasma and tissue ghrelin levels

Gulcan Sahin-Eryilmaz et al.

TURKISH JOURNAL OF GASTROENTEROLOGY (2018)

Review Gastroenterology & Hepatology

Future Treatment of Constipation-associated Disorders: Role of Relamorelin and Other Ghrelin Receptor Agonists

Paula Mosinska et al.

JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY (2017)

Article Medicine, General & Internal

Chronic pancreatitis

Jorg Kleeff et al.

NATURE REVIEWS DISEASE PRIMERS (2017)

Article Cell Biology

Antinociceptive Effect of Ghrelin in a Rat Model of Irritable Bowel Syndrome Involves TRPV1/Opioid Systems

Yuqing Mao et al.

CELLULAR PHYSIOLOGY AND BIOCHEMISTRY (2017)

Review Gastroenterology & Hepatology

Systematic review: interventions for abdominal pain management in inflammatory bowel disease

C. Norton et al.

ALIMENTARY PHARMACOLOGY & THERAPEUTICS (2017)

Article Gastroenterology & Hepatology

A Randomized Phase III Clinical Trial of Plecanatide, a Uroguanylin Analog, in Patients With Chronic Idiopathic Constipation

Philip B. Miner et al.

AMERICAN JOURNAL OF GASTROENTEROLOGY (2017)

Article Gastroenterology & Hepatology

Centrally Mediated Disorders of Gastrointestinal Pain

Laurie Keefer et al.

GASTROENTEROLOGY (2016)

Article Gastroenterology & Hepatology

The Role of Visceral Hypersensitivity in Irritable Bowel Syndrome: Pharmacological Targets and Novel Treatments

Mohammad H. Farzaei et al.

JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY (2016)

Review Gastroenterology & Hepatology

Emerging treatments in Neurogastroenterology: relamorelin: a novel gastrocolokinetic synthetic ghrelin agonist

M. Camilleri et al.

NEUROGASTROENTEROLOGY AND MOTILITY (2015)

Article Gastroenterology & Hepatology

Oxytocin regulates gastrointestinal motility, inflammation, macromolecular permeability, and mucosal maintenance in mice

Martha G. Welch et al.

AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY (2014)

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Chloroform Extract of Underground Parts of Ferula heuffelii: Secondary Metabolites and Spasmolytic Activity

Ivan Pavlovic et al.

CHEMISTRY & BIODIVERSITY (2014)

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Olanzapine for the prevention and treatment of chronic nausea and chemotherapy-induced nausea and vomiting

Rudolph M. Navari

EUROPEAN JOURNAL OF PHARMACOLOGY (2014)

Article Gastroenterology & Hepatology

Oxytocin analogues have potential in relieving chronic abdominal pain

Katrina Ray

Nature Reviews Gastroenterology & Hepatology (2014)

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Efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea and anxiety

Ling Lan et al.

WORLD JOURNAL OF GASTROENTEROLOGY (2014)

Review Gastroenterology & Hepatology

Neuroanatomy of lower gastrointestinal pain disorders

Wim Vermeulen et al.

WORLD JOURNAL OF GASTROENTEROLOGY (2014)

Article Multidisciplinary Sciences

Selenoether oxytocin analogues have analgesic properties in a mouse model of chronic abdominal pain

Aline Dantas de Araujo et al.

NATURE COMMUNICATIONS (2014)

Article Medicine, General & Internal

In vivo and in vitro hypotensive effect of aqueous extract of Moringa stenopetala

M. Mengistu et al.

AFRICAN HEALTH SCIENCES (2012)

Article Gastroenterology & Hepatology

Efficacy of Buspirone, a Fundus-Relaxing Drug, in Patients With Functional Dyspepsia

Jan Tack et al.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2012)

Review Medicine, General & Internal

Evaluation and management of acute abdominal pain in the emergency department

Christopher R. Macaluso et al.

INTERNATIONAL JOURNAL OF GENERAL MEDICINE (2012)

Review Gastroenterology & Hepatology

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: Systematic review and meta-analysis

M. A. Martinez-Vazquez et al.

REVISTA DE GASTROENTEROLOGIA DE MEXICO (2012)

Article Plant Sciences

Pharmacological studies on Hypericum perforatum fractions and constituents

Arif-ullah Khan et al.

PHARMACEUTICAL BIOLOGY (2011)

Review Gastroenterology & Hepatology

Systematic review of modulators of benzodiazepine receptors in irritable bowel syndrome: Is there hope?

Pooneh Salari et al.

WORLD JOURNAL OF GASTROENTEROLOGY (2011)

Review Pharmacology & Pharmacy

Implications of Melatonin Therapy in Irritable Bowel Syndrome: A Systematic Review

Shilan Mozaffari et al.

CURRENT PHARMACEUTICAL DESIGN (2010)

Review Biochemistry & Molecular Biology

Orexins and Gastrointestinal Functions

M. C. Baccari

CURRENT PROTEIN & PEPTIDE SCIENCE (2010)

Article Integrative & Complementary Medicine

Effects of Two Natural Medicine Formulations on Irritable Bowel Syndrome Symptoms: A Pilot Study

Jason A. Hawrelak et al.

JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE (2010)

Article Biochemistry & Molecular Biology

Covariation of plasma ghrelin and motilin in irritable bowel syndrome

Kristina Sjolund et al.

PEPTIDES (2010)

Review Gastroenterology & Hepatology

A systematic review of efficacy and tolerability of mebeverine in irritable bowel syndrome

Mahnaz Darvish-Damavandi et al.

WORLD JOURNAL OF GASTROENTEROLOGY (2010)

Article Gastroenterology & Hepatology

Atypical Antipsychotic Quetiapine in the Management of Severe Refractory Functional Gastrointestinal Disorders

Madhusudan Grover et al.

DIGESTIVE DISEASES AND SCIENCES (2009)

Article Medicine, Research & Experimental

Ghrelin in patients with irritable bowel syndrome

M. El-Salhy et al.

INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE (2009)

Editorial Material Gastroenterology & Hepatology

Efficacy of tricyclic antidepressants in irritable bowel syndrome: A meta-analysis

Roja Rahimi et al.

WORLD JOURNAL OF GASTROENTEROLOGY (2009)

Review Gastroenterology & Hepatology

Pain in chronic pancreatitis: the role of neuropathic pain mechanisms

A. M. Drewes et al.

Article Agriculture, Multidisciplinary

Inhibition of human cAMP-phosphodiesterase as a mechanism of the spasmolytic effect of Matricaria recutita L.

Omar Maschi et al.

JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY (2008)

Article Agricultural Engineering

Herb and oil composition of dill (Anethum graveolens L.):: Effects of crop maturity and plant density

Nancy W. Callan et al.

INDUSTRIAL CROPS AND PRODUCTS (2007)

Article Gastroenterology & Hepatology

Alterations in expression of p11 and SERT in mucosal biopsy specimens of patients with irritable bowel syndrome

Michael Camilleri et al.

GASTROENTEROLOGY (2007)

Article Gastroenterology & Hepatology

Serotonergic and non-serotonergic targets in the pharmacotherapy of visceral hypersensitivity

L. Bueno et al.

NEUROGASTROENTEROLOGY AND MOTILITY (2007)

Article Gastroenterology & Hepatology

Peripheral and central mechanisms of visceral sensitization in man

P. Anand et al.

NEUROGASTROENTEROLOGY AND MOTILITY (2007)

Article Gastroenterology & Hepatology

Curcumin maintenance therapy for ulcerative colitis: Randomized, multicenter, double-blind, placebo-controlled trial

Hiroyuki Hanai et al.

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY (2006)

Article Plant Sciences

Norsecofriedelanes as spasmolytics, advances of structure-activity relationships

M González-Cortazar et al.

PLANTA MEDICA (2005)

Article Pharmacology & Pharmacy

Antispasmodic activity of fractions and cynaropocrin from Cynara scolymus on guinea-pig ileum

F Emendörfer et al.

BIOLOGICAL & PHARMACEUTICAL BULLETIN (2005)

Article Gastroenterology & Hepatology

Pain intensity and biomechanical responses during ramp-controlled distension of the human rectum

P Petersen et al.

DIGESTIVE DISEASES AND SCIENCES (2003)

Article Gastroenterology & Hepatology

Randomized, double-blind, placebo-controlled trial of prednisolone in post-infectious irritable bowel syndrome

SP Dunlop et al.

ALIMENTARY PHARMACOLOGY & THERAPEUTICS (2003)

Review Neurosciences

Can we conquer pain?

J Scholz et al.

NATURE NEUROSCIENCE (2002)

Article Pharmacology & Pharmacy

SB-334867-A: the first selective orexin-1 receptor antagonist

D Smart et al.

BRITISH JOURNAL OF PHARMACOLOGY (2001)