Loperamide Treatment of the Irritable Bowel Syndrome

Hovdenak, Nils

doi:10.3109/00365528709091004

Cited by 123 publications

(77 citation statements)

References 4 publications

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“…Unfortunately, studies on antidiarrheal agents other than loperamide hydrochloride for the treatment of IBS are rarely found in the United States or Europe. Several small-scale RCTs have been conducted overseas to investigate the efficacy of loperamide hydrochloride in IBS patients [113][114][115] and the agent was found effective at improving defecation frequency and stool consistency. However, due to inconsistent study results, consensus has not been reached on whether loperamide hydrochloride improves gastrointestinal symptoms such as abdominal pain.…”

Section: Cq Are Anti-diarrheal Agents Effective In Treating Ibs-d?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for irritable bowel syndrome

et al. 2014

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New strategies for the care of irritable bowel syndrome (IBS) are developing and several novel treatments have been globally produced. New methods of care should be customized geographically because each country has a specific medical system, life style, eating habit, gut microbiota, genes and so on. Several clinical guidelines for IBS have been proposed and the Japanese Society of Gastroenterology (JSGE) subsequently developed evidence-based clinical practice guidelines for IBS. Sixty-two clinical questions (CQs) comprising 1 definition, 6 epidemiology, 6 pathophysiology, 10 diagnosis, 30 treatment, 4 prognosis, and 5 complications were proposed and statements were made to answer to CQs. A diagnosis algorithm and a three-step treatment was provided for patients with chronic abdominal pain or abdominal discomfort and/or abnormal bowel movement. If more than one alarm symptom/sign, risk factor and/or routine examination is positive, colonoscopy is indicated. If all of them, or the subsequent colonoscopy, are/is negative, Rome III or compatible criteria is applied. After IBS diagnosis, step 1 therapy consisting of diet therapy, behavioral modification and guttargeted pharmacotherapy is indicated for four weeks. Nonresponders to step 1 therapy proceed to the second step that includes psychopharmacological agents and simple psychotherapy for four weeks. In the third step, for patients nonresponsive to step 2 therapy, a combination of gut-targeted pharmacotherapy, psychopharmacological treatments and/or specific psychotherapy is/are indicated. Clinical guidelines and consensus for IBS treatment in Japan are well suited for Japanese IBS patients; as such, they may provide useful insight for IBS treatment in other countries around the world.

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Section: Cq Are Anti-diarrheal Agents Effective In Treating Ibs-d?mentioning

confidence: 99%

Evidence-based clinical practice guidelines for irritable bowel syndrome

et al. 2014

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“…Whether the diarrhea seems to improve, the abdominal pain was not changed in diarrhea-predominant IBS. Patients with alternating bowel habits had no improvement, whereas the constipation-predominant IBS patients have worsening of their symptoms (Hovdenak, 1987). Prokinetics agents have no significant efficacy in the treatment of IBS .…”

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confidence: 99%

Pregabalin (CI-1008) Inhibits the Trinitrobenzene Sulfonic Acid-Induced Chronic Colonic Allodynia in the Rat

Diop¹,

Raymond²,

Fargeau³

et al. 2002

J Pharmacol Exp Ther

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In human, digestive disorders are often associated with visceral pain. In these pathologies, visceral pain threshold is decreased indicating a visceral hypersensitivity. Pregabalin [CI-1008; S-(ϩ)-3-isobutylgaba] presents antihyperalgesic actions in inflammatory somatic pain models. This study was designed to evaluate 1) the effect of injection of TNBS into the colon on visceral pain threshold, and 2) the antihyperalgesic effect of pregabalin on TNBS-induced chronic colonic allodynia. A significant decrease in the colonic pain threshold was observed in trinitrobenzene sulfonic acid (TNBS)-treated animals (17.8 Ϯ 1.27 versus 43.4 Ϯ 1.98 mm Hg). Pregabalin (30 -200 mg/kg s.c.) and morphine (0.1-1 mg/kg s.c.) showed a dose-related inhibition of TNBS-induced colonic allodynia. Pregabalin did not inhibit the colonic inflammatory effect of TNBS. In normal conditions (control animals), morphine (0.3 mg/kg s.c.) significantly increased the colonic pain threshold, whereas pregabalin (200 mg/kg s.c.) did not modify the colonic pain threshold. Pregabalin suppressed the TNBS-induced colonic allodynia but did not modify the colonic threshold in normal conditions. The ability of pregabalin to block the chronic colonic allodynia indicates that it is effective in abnormal colonic hypersensitivity, suggesting a possible effect in chronic pain in irritable bowel syndrome.

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“…This class of drugs works by inhibiting intestinal secretion and increasing fluid and electrolyte absorption because of prolongation of intestinal transit time. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS [66][67][68][69] as confirmed by a meta-analysis of controlled trials of good quality [30]. Urgency and borborygmi may also be improved.…”

Section: Antidiarrhoealsmentioning

confidence: 90%

Evaluation of drug treatment in irritable bowel syndrome

Talley

2003

Brit J Clinical Pharma

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The irritable bowel syndrome (IBS) remains a therapeutic challenge in part because of the limited understanding of the pathophysiology. The placebo response rate varies in randomized controlled trials from 20 to 70%, and can persist for up to at least 1 year. It is contentious whether dietary fibre and bulking agents relieve the symptoms of IBS; constipation probably improves. Anticholinergic and antispasmodic agents are of questionable benefit in IBS despite positive meta-analyses of poor quality trials. A meta-analysis concluded that the tricyclic antidepressants were superior to placebo in IBS, although the individual trial results were variable. Selective serotonin reuptake inhibitors are of uncertain benefit. Laxatives are used for constipation but probably poorly control the IBS symptom complex. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS. Tegaserod is a well-tolerated aminoguanidine indole derivative of serotonin that is a partial 5HT 4 -receptor agonist with prokinetic properties; a therapeutic gain over placebo of 5% to 15% has been observed in constipation-predominant IBS in females. Alosetron is a 5HT 3 -receptor antagonist that is efficacious in females with diarrhoea-predominant IBS, with a 12% to 17% therapeutic gain; the risk of ischaemic colitis is 1 in 350, with very severe constipation occurring in about 1 in 1000. Optimizing study design remains a challenge in IBS. New visceral analgesic and motility modifying agents, as well as anti-inflammatory agents are in trials, and hopefully additional efficacious therapeutic options for patients with IBS will soon emerge.

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Loperamide Treatment of the Irritable Bowel Syndrome

Cited by 123 publications

References 4 publications

Evidence-based clinical practice guidelines for irritable bowel syndrome

Evidence-based clinical practice guidelines for irritable bowel syndrome

Pregabalin (CI-1008) Inhibits the Trinitrobenzene Sulfonic Acid-Induced Chronic Colonic Allodynia in the Rat

Evaluation of drug treatment in irritable bowel syndrome

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