Irritable bowel syndrome treatment

L.A. Sorbera, J. Castaner, N.E. Mealy, Lubiprostone. Treatment of constipation, treatment of irritable bowel syndrome, treatment of postoperative ileus, CIC-2 channel activator, Drugs Fut. 29 (2004) 336-342. 

Roffman RA, Barnhart R Assessing need for marijuana dependence treatment through an anonymous telephone interview. Int J Addict 22 639-631, 1987 Russo EB Clinical endocannabinoid deficiency (CECD) can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions Neuro Endocrinol Lett 25(1-2) 31—39, 2004... 

TABLE 18-5. Common Pharmacologic Treatments for Irritable Bowel Syndrome... 

We gave patients suffering from irritable bowel syndrome three doses of a therapeutic relationship. The lowest dose was no relationship with the medical practitioner and no treatment at all. These patients were simply assessed and put on a waiting list, with the promise that they would receive treatment some... 

If you look in the medical literature, you will often see the term placebo defined as a non-specific treatment. What does it mean to say that a treatment is not specific It could mean that the treatment is effective for many different disorders, rather than for only one particular condition. In this sense, placebos are indeed non-specific. Besides depression, placebos have been shown to affect anxiety, pain, ulcers, irritable bowel syndrome, Parkinson s disease, angina, autoimmune diseases, Alzheimer s disease, rheumatoid arthritis, asthma, gastric function, sexual dysfunction and skin conditions. We know this from the thousands of studies in which placebos have been used as control conditions, against which the effects of medication have been evaluated, and from studies that were specifically designed to assess the placebo effect. 

Ionic motility patterns similar to those with irritable bowel syndrome [25], and patients with asymptomatic disease have colonic myoelectric activity similar to that of normals [49]. A fundamental issue is that treatment with rifaximin may be related to colonic symptoms rather than to diverticula per se this would suggest the inclusion, in future studies, of an additional arm of patients with symptoms of irritable bowel syndrome but not diverticula. 

In the periphery, 5-HT4 receptor mRNA is found in vascular smooth muscle. Newly developed drugs that activate 5-HT4 receptors are of interest for their potential in treating cardiac arrhythmia. The 5-HT4 receptor is also located on neurons of the alimentary tract, for example the myenteric plexus of the ileum, and on smooth muscle cells and secretory cells of the gastrointestinal tract, where they evoke secretions and the peristaltic reflex. 5-HT4 receptor agonists (e.g. cisapride, prucalopride, tegaserod) are used therapeutically in the treatment of constipation-predominant irritable bowel syndrome and in functional motility disorders of the upper gastrointestinal tract. 

The recent approval of the SNRI duloxetine for the treatment of diabetic neuropathy reinforces the utility of this drug class in the treatment of neuropathic pain. Other largely untapped areas which remain to be exploited with this drug class include sexual dysfunction, such as premature ejaculation, irritable bowel syndrome, obesity, neurodegenerative diseases such as Parkinson s disease, restless leg syndrome, and substance abuse and addiction. It is apparent that considerable opportunities for drug discovery will exist in this area for some time to come. 

Irritable bowel syndrome (IBS) affects 10-22% of the general population (54) and results in high health care utilization (55). The pathophysiology is not clearly defined diet, psychological distress, infection, altered mucosal immunity, visceral hypersensitivity, intestinal dysmotility, and abnormal brain-gut interactions are potential mechanisms for this disorder (56). Treatment options vary and are generally selected based on the patient s primary symptom. 

In the treatment of irritable bowel syndrome, often a therapeutic dilemma, there is some evidence that a high fibre maintenance diet combined with short-term antispasmodics may be beneficial. 

Evans BW, Clark WK, Moore DJ, Whorwell PJ. Tegaserod for the treatment of irritable bowel syndrome and chronic constipation. Cochrane Database Syst Rev 2007. 

Heading R, Bardhan K, Hollerbach S, Lanas A, Fisher G. Systematic review the safety and tolerability of pharmacological agents for treatment of irritable bowel syndrome - a European experience. Aliment Pharmacol Ther 2006 24 207-36. 

Nonselective antimuscarinic drugs have been employed in the therapy of peptic ulcers (see Chapter 40) because they can reduce gastric acid secretion they also have been used as adjunctive therapy in the treatment of irritable bowel syndrome. Antimuscarinic drugs can decrease the pain associated with postprandial spasm of intestinal smooth muscle by blocking contractile responses to ACh. Some of the agents used for this disorder have only antimuscarinic activity (e.g., propantheline), while other drugs have additional properties that contribute to their antispasmodic action. Dicyclomine (Bentyl) and oxybutynin (Ditropan) at therapeutic concentrations primarily have a direct smooth muscle relaxant effect with little antimuscarinic action. 

Friedman C. Treatment of the irritable bowel syndrome. Gastroenterol Clin North Aml991 20 325-333. 

C. Ginkgo would be the most likely herbal treatment to benefit this patient, since it would improve cerebrovascular blood flow and cognitive function. Vertigo and tinnitus may also respond, although there is more evidence for the former. GarUc is traditionally used for cardiovascular benefits (Upid, blood pressure reduction), but it would be unlikely to produce immediate results. Peppermint is used as an antispasmodic in irritable bowel syndrome, while ginger tea is a common carminative (gas reducer) and motion sickness treatment. Valerian is useful as a sedative. 

B. Greenwood, Muscarinic analgesics with potent and selective effects on the gastrointestinal tract Potential application for the treatment of irritable bowel syndrome, J. Med. Chem. 40 (1997) 538-546. 

The standard pharmacokinetic parameters of the compound such as a half-life or bioavailability cannot be reliably calculated, because the concentrations in plasma are below lOpg/mL. As analogously expected from the results on the shift in keto-alcohol equilibrium of 16,16-difluoro-PGE2, it is rapidly metabolized by C-15 reduction mediated by the ubiquitously expressed carbonyl reductase. The metabolism followed by jS-oxidation and co-oxidation forms a mixture of a and fi epimers at the 15-hydroxy moiety as a sole measurable metabolite [46], In 2006, the US Food and Drug Administration approved the drug application for an oral treatment of chronic idiopathic constipation in adults, estimating that 4-5 million Americans are affected. Lubiprostone has also completed a phase II trial in constipation-predominant irritable bowel syndrome, and has been further evaluated for other bowel dysfunctions. 

Laxative effect. Seed hull, taken orally by adults at a dose of 7 g/person, increased weekly fecal mass without influencing transit time or frequency . Seedcoat, administered orally to 80 patients at a dose of 6.4 g/person three times daily, was active in a blinded placebo controlled study of efficacy of extract in treatment of irritable bowel syndrome " . Water extract of the dried kernel, administered orally to 40-year-old adults of both sexes, was active . Seed powder, administered orally to adults of both sexes, was active. Biological activity reported has been patented ". Dried seeds, administered orally to adults at a dose of 0.5 g/person, were active. Placing the seeds in water increased their volume, 90% alcohol produced a decrease in volume to normal seed size, and linseed oil had no effect on volume. The seed mucilage remained in gel form and is considered preferable to the solid form because it is more easily digested " . Dried seed powder, administered orally to 35 patients with chronic constipation at a dose of 50 mg/person, was active in a controlled, double-blind study " . Fiber, administered orally to adults, was active. Psyllium fiber and sennosides were prepared into a wafer to be... 

Emmanuel, N.P., Lydlard, R.B., and Crawford, M. (1997) Treatment of irritable bowel syndrome with fluvoxamine. Am Psychiatry 154 711-712. 

G. Other applications Limited data show some beneficial effects of leuprolide in the treatment of breast cancer. According to Micromedex, there is good documentation that leuprolide is effective for bowel pain and nausea associated with irritable bowel syndrome. Leuprolide has been used for controlled ovarian hyperstimulation to enhance the in vitro fertilization-embryo transfer procedure. In endometriosis, the goal of treatment is pain relief and reduction of endometriotic lesions. In children with central precocious puberty, stimulated and basal gonadotropins are reduced to prepubertal levels. Testosterone and estradiol are reduced to prepubertal levels in males and females, respectively. 

Cisapride, a 5-HT4 agonist, was used in the treatment of gastroesophageal reflux and motility disorders. Because of toxicity, it is now available only for compassionate use in the USA. Tegaserod, a 5-HT4 partial agonist, is used for irritable bowel syndrome with constipation. These drugs are discussed in Chapter 62. 

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