Dietary and pharmacological treatment of abdominal pain in IBS

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-HT 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-HT 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).

Analgesia and mouse strain influence neuromuscular plasticity in inflamed intestine

“…For research animals, provision of analgesia is an obligation that is becoming better recognized and acknowledged as an approachable challenge that need not affect outcome in models involving intestinal pain, as in the IBD models studied here, or elsewhere . Optimal treatment in animals can aid the translation to human medicine, where the challenge of intestinal pain is frequently met with opioids for non‐inflammatory (irritable bowel syndrome; IBS) or inflammatory (IBD) conditions …”

Focus on current and future management possibilities in inflammatory bowel disease-related chronic pain

“…More recently, anticonvulsants, predominately gabapentin and pregabalin, have been used to treat visceral pain [56]. Recent studies of gabapentin and pregabalin have shown beneficial effects on visceral hypersensitivity [57, 58].…”

Ameliorating effects of optimized gastric electrical stimulation and mechanisms involving nerve growth factor and opioids in a rodent model of gastric hypersensitivity

“…It is unknown whether NGF plays a major role in the rodent model of FD and whether the possible GES effects on gastric hypersensitivity might be mediated via the NGF mechanism. Opioids, such as μ‐opioid receptor (OR), κ‐OR agonist, and δ‐OR antagonist (eluxadoline), have been used to treat pain, including visceral pain in gastrointestinal functional disorders, such as irritable bowel syndrome . We were also interested in possible analgesic effects of GES on opioid mechanisms.…”