Naloxone treatment for irritable bowel syndrome — a randomized controlled trial with an oral formulation

Hawkes, Neil; Rhodes, J.; Evans, Bruce; Rhodes, P.; Hawthorne, A. B.; Thomas, G. A. O.

doi:10.1046/j.1365-2036.2002.01320.x

Cited by 48 publications

(39 citation statements)

References 25 publications

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“…On the other hand, asimadoline was not effective in 155 IBS patients who had been administered the drug as needed for 4 weeks in a population-based study, although the follow-up rate was low at 62.6 % [153]. In an RCT, 6-week administration of fedotozine improved the symptoms of 238 IBS patients [154], and in another RCT, 8-week administration of the opioid receptor antagonist naloxone improved, albeit not significantly, the symptoms of 28 IBS patients [155]. No consensus has been drawn from these findings.…”

Section: Commentmentioning

confidence: 93%

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: Commentmentioning

confidence: 93%

Evidence-based clinical practice guidelines for irritable bowel syndrome

et al. 2014

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“…There is quite a large literature on IBS and endorphins 48,49 . Several trials have investigated the physiologic mechanisms of acupuncture.…”

Section: Cam Approaches To Ibs Treatmentmentioning

confidence: 99%

The Integration of Complementary and Alternative Medicine:The Way Forward for the Health of Skin and Gut

Kalsi

Ryan

2016

Current Science

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In this review of Sanskrit translations in traditionalAyurveda texts studies on skin and gut health we consider the integration of complementary and alternative medicine (CAM) with biomedicine (BM). We focus on irritable bowel syndrome (IBS) as a problem affecting 22% of the population with multiple known causes and unresponsive to biomedical and CAM intervention, but for which integrated medicine (IM) might be more useful. As up to 80% of medical patients concurrently use CAM alongside BM, it is imperative that doctors are able to understand and discuss its use with patients. In order to facilitate these therapeutic combinations, we must identify safe and effective CAM treatment protocols for their administration. CAM offers many treatment options, especially for IBS; however, its presentation can prove a barrier to understanding these options. Here, we consider the example of Ayurveda: a traditional Indian system of medicine in which derangements of the digestive system are well described but with unclear English translations. Forceful language and opinions are sometimes used to support traditional medicine. These unscientific obstacles detract from the multitude of treatment options CAM provides. If CAM were presented in a more scientific manner, modern medical practitioners would take IM more seriously. Research of CAM often lacks scientific rigour, leaving questions regarding its evidence base. Moreover, CAM literature does not utilize advances in the understanding of disease and epidemiology. BM has been less successful at disease prevention and managing chronic conditions while CAM focuses on optimizing health, even in the absence of obvious pathology. Patients are now more focused on health optimization leading to increased uptake of CAM. The onus is on us as health professionals to make sure that they are able to do this as safely and effectively as possible.

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“…Kappa receptor agonists such as fedotozine are used as visceral analgesics and mu agonists that are not systemically absorbed, such as loperamide, are given for treating diarrhea [101] . In a clinical trial for treatment of IBS with constipation, naloxone was effective in reducing constipation and thus improving the quality of life [102] .…”

Section: Imbalance In Endogenous Opioids In Gastrointestinal Diseasesmentioning

confidence: 99%

Opioid-Induced Gastrointestinal Dysfunction

Mehendale¹,

Yuan²

2006

Dig Dis

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Use of opioid analgesics is associated with a number of side effects, especially opioid-induced gastrointestinal dysfunction. The extensive use of these compounds and the significant negative impact of the resulting gastrointestinal dysfunction on patients’ quality of life make it an important clinical issue. In recent years our understanding of the mechanisms of opioid-induced gastrointestinal dysfunction has advanced greatly. This article reviews the underlying pathophysiological mechanisms of specific gastrointestinal adverse effects of opioids. The role of endogenous opioid peptides in certain gastrointestinal diseases is also discussed. A better understanding of the pathophysiological mechanisms of opioid-induced bowel dysfunction should lead to the development of newer opioid analgesics and improved regimens resulting in reduced gastrointestinal adverse effects.

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Naloxone treatment for irritable bowel syndrome — a randomized controlled trial with an oral formulation

Cited by 48 publications

References 25 publications

Evidence-based clinical practice guidelines for irritable bowel syndrome

Evidence-based clinical practice guidelines for irritable bowel syndrome

The Integration of Complementary and Alternative Medicine:The Way Forward for the Health of Skin and Gut

Opioid-Induced Gastrointestinal Dysfunction

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