New regimen for treatment of irritable bowel syndrome with emphasis on Sulpride as the sole maintenance therapy

The efficiency and safety of Sulpirid (50 mg twice/daily) was assessed in 563 adult patients with 6 groups of patients with irritable bowel syndrome (IBS) who had failed dietary therapy. The groups included; patients without previous treatment (n: 137), patients who had received a muscarinic antagonists (n: 65), an anticholinergic/benzodiazepine combination (n: 187), a tricyclic antidepressants (n: 62), a selective serotonin reuptake inhibitors (SSRIs) (n: 48) and an antiflatulent (n: 64). Patients were assessed for 6 weeks. Sulpirid was effective and safe in safe in relieving the abdominalgia, anxiety, depression and bowel function. The overall success of Sulpride in treatment of IBS was 84%. Most patients who had failed muscarinic antagonists, antiflatulent and tricyclic antidepressants had > 95% improvement with Sulpride. The success was 88% in those who did not receive prior therapy while it was just 77% and 72% in those who had failed SSRIs and anticholinergic/benzodiazepine combination. In treatment-failures, a further 9.8% improvement was achieved with addition of a SSRI (Escitalopram) and an extra 3.4% with subsequent increase in Sulpride dose to 100 mg X 2 limiting failures to only 2.3%. Tolerance of treatment was good and side-effects developed in 11% patients. In conclusion: Sulpride is an effective and safe drug in IBS. Keywords: Antidepressants, anxiolytics, irritable bowel syndrome, treatment, Sulpride

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Sleep and gastric function in irritable bowel syndrome: derailing the brain-gut axis

Gut ◽

10.1136/gut.41.3.390 ◽

1997 ◽

Vol 41 (3) ◽

pp. 390-393 ◽

Cited By ~ 71

Author(s):

W C Orr ◽

M D Crowell ◽

B Lin ◽

M J Harnish ◽

J D Z Chen

Keyword(s):

Irritable Bowel Syndrome ◽

Rem Sleep ◽

Bowel Function ◽

Control Group ◽

Gastric Function ◽

Subsequent Increase ◽

Surface Electrodes ◽

Non Invasive ◽

Irritable Bowel ◽

The Brain

Background—Recently, several studies have shown an alteration in bowel function during sleep in patients with irritable bowel syndrome (IBS), and a recent study also suggests a remarkable increase in rapid eye movement (REM) sleep. These studies have suggested that an alteration in CNS function may play an important role in the pathogenesis of IBS.Aims—To confirm the presence of an alteration in REM sleep in patients with IBS and to assess the relation between sleep and a non-invasive measure of gastric functioning, the electrogastrogram (EGG).Patients—Ten patients with IBSand 10 age and sex matched normal volunteers.Methods—All subjects slept one night in the sleep laboratory and underwent polysomnographic monitoring to determine sleep patterns, and recording of the EGG from surface electrodes.Results—The IBS group had a notable and significant increase in the percentage and duration of REM sleep (p<0.05). The control group had a decrease in the amplitude of the dominant EGG frequency from waking to non-REM sleep (p<0.05), and a subsequent increase in the amplitude from non-REM to REM sleep (p<0.05). No such changes were noted in the patients with IBS.Conclusions—Results confirmed the enhancement of REM sleep in patients with IBS and suggested an intrinsic alteration in autonomic and CNS functioning in patients with IBS.

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Clinical Application of Dietary Therapies in Irritable Bowel Syndrome

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.273.avy ◽

2018 ◽

Vol 27 (3) ◽

pp. 307-316 ◽

Cited By ~ 12

Author(s):

Anupam Rej ◽

Amanda Avery ◽

Alexander Charles Ford ◽

Anne Holdoway ◽

Matthew Kurien ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Randomized Trials ◽

Individual Therapy ◽

Dietary Therapy ◽

Round Table Discussion ◽

Mesh Terms ◽

Number Of Patients ◽

Significant Difference ◽

Irritable Bowel ◽

Fodmap Diet

Background & Aims: Diet appears to play a pivotal role in symptom generation in Irritable Bowel Syndrome (IBS). First line dietary therapy for IBS has focused on advice concerning healthy eating and lifestyle management. Research recently has focused on the role of a diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs), gluten free (GFD) and wheat free (WFD) diets for the relief of symptoms in IBS.Methods: A round table discussion with gastroenterologists and dietitians with a specialist interest in dietary therapies in IBS was held in Sheffield, United Kingdom in May 2017. Existing literature was reviewed. PubMed and EMBASE were searched with the MeSH terms irritable bowel syndrome/diet/diet therapy/gluten/low FODMAP in different combinations to identify relevant articles. A consensus on the application of these dietary therapies into day-to-day practice was developed. Results: Fourteen randomized trials in IBS evaluating the low FODMAP diet (n studies = 9), GFD (n = 4) and WFD (n = 1) were included in this review. The total number of patients recruited from randomized trials reviewed was: n=580 low FODMAP diet (female, n=430), n=203 GFD (female, n=139), n=276 WFD (female, n=215). There was no significant difference in the gender of patients recruited for both the low FODMAP and GFD randomized studies (p=0.12). The response rate in the literature to a low FODMAP diet ranged between 50-76%, and to GFD ranged between 34-71%. Percentage of IBS patients identified as wheat sensitive was reported as 30% in the literature. Conclusion: There are no head-to-head trials to date utilizing the low FODMAP diet, GFD and WFD for dietary treatment of IBS and still a number of concerns for diets, including nutritional inadequacy and alteration of the gut microbiota. The consensus suggests that there is evidence for the use of the low FODMAP diet, GFD and WFD as dietary therapies for IBS; the decision-making process for using each individual therapy should be directed by a detailed history by the dietitian, involving the patient in the process.

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“Power” of Selective Serotonin Reuptake Inhibitors in Irritable Bowel Syndrome

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2009.10.027 ◽

2010 ◽

Vol 8 (3) ◽

pp. 313-314 ◽

Cited By ~ 2

Author(s):

Alexander C. Ford ◽

Paul Moayyedi

Keyword(s):

Irritable Bowel Syndrome ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Irritable Bowel

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Management of irritable bowel syndrome with diarrhea: a review of nonpharmacological and pharmacological interventions

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819878950 ◽

2019 ◽

Vol 12 ◽

pp. 175628481987895 ◽

Cited By ~ 8

Author(s):

David J. Cangemi ◽

Brian E. Lacy

Keyword(s):

Irritable Bowel Syndrome ◽

Selective Serotonin Reuptake Inhibitors ◽

Lifestyle Modification ◽

Behavioral Therapy ◽

Management Plan ◽

Pharmacological Interventions ◽

Bile Acid Sequestrants ◽

Psychological Therapies ◽

Symptom Intensity ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition involving numerous potential causative factors (e.g. alterations in gut microbiota, motility, brain–gut axis). Several interventions are available for the management of patients with IBS, but no universal management algorithm currently exists. The aim of this article is to review interventions that may be considered in the management of patients with IBS with diarrhea (IBS-D). Nonpharmacological interventions include dietary and lifestyle modification, which are generally used as first-line therapy. Probiotics have demonstrated efficacy and safety in patients with IBS, but studies are inconsistent in strains examined, dosing, and treatment duration. Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy) also may improve IBS symptoms. Pharmacological interventions for the management of IBS-D include the US Food and Drug Administration–approved agents eluxadoline, rifaximin, and alosetron, as well as loperamide, smooth muscle antispasmodics, bile acid sequestrants, and antidepressants (i.e. tricyclic antidepressants, selective serotonin reuptake inhibitors). Eluxadoline and rifaximin have been shown to improve abdominal pain and stool consistency in patients with IBS-D. In addition, data indicate that alosetron improves IBS symptoms; however, it is approved only for women with severe IBS-D. Of the three approved agents, rifaximin has the most favorable safety profile. The risk–benefit ratio is an important consideration with every medication, but is especially important in the treatment of functional GI disorders such as IBS-D. Thus, the most troublesome symptoms, quality of life, symptom intensity, and individual patient preferences should be considered when formulating a management plan for patients with IBS-D.

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Do corticotropin releasing factor-1 receptors influence colonic transit and bowel function in women with irritable bowel syndrome?

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00011.2009 ◽

2009 ◽

Vol 296 (6) ◽

pp. G1299-G1306 ◽

Cited By ~ 78

Author(s):

Seth Sweetser ◽

Michael Camilleri ◽

Sara J. Linker Nord ◽

Duane D. Burton ◽

Lorna Castenada ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Colonic Motility ◽

Bowel Function ◽

Colonic Transit ◽

Corticotropin Releasing Factor ◽

Analysis Of Covariance ◽

Eligibility Criteria ◽

Double Blind ◽

Safety Issues ◽

Irritable Bowel

Corticotropin releasing factor (CRF), a mediator of stress response, alters gastrointestinal (GI) functions. Stress-related changes in colonic motility are blocked by selective CRF1 receptor antagonists. Our aim was to assess whether modulation of central and peripheral CRF1 receptors affects colonic transit and bowel function in female patients with diarrhea-predominant irritable bowel syndrome (D-IBS). This randomized, double-blind, placebo-controlled, 2-wk study evaluated the effects of oral pexacerfont (BMS-562086), a selective CRF1 receptor antagonist, 25 and 100 mg qd, on GI and colonic transit of solids [by validated scintigraphy with primary end point colonic geometric center (GC) at 24 h] and bowel function (by validated daily diaries) in 39 women with D-IBS. The 100-mg dose was comparable to a dose that inhibited colonic motility in stressed rats. Treatment effects were compared by analysis of covariance with baseline colonic transit as covariate. The study had 80% power (α = 0.05) to detect clinically meaningful (26%) differences in colonic transit. Thirty-nine of 55 patients fulfilled eligibility criteria (9 screen failures, 5 baseline GC24 outside prespecified range). At baseline, three treatment groups had comparable age, body mass index, and GC 24 h. Significant effects of pexacerfont relative to placebo were not detected on colonic GC24 ( P = 0.53), gastric emptying, orocecal transit, ascending colon emptying half-time, and stool frequency, consistency, and ease of passage. No safety issues were identified. We conclude that in women with D-IBS, pexacerfont, 25 or 100 mg qd, does not significantly alter colonic or other regional transit or bowel function. The role of central and peripheral CRF1 receptors in bowel function in D-IBS requires further study.

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Lubiprostone decreases abdominal discomfort and improves bowel function in patients with irritable bowel syndrome (IBS) with constipation,

Inpharma Weekly ◽

10.2165/00128413-200615410-00018 ◽

2006 ◽

Vol &NA; (1541) ◽

pp. 9

Author(s):

&NA;

Keyword(s):

Irritable Bowel Syndrome ◽

Bowel Function ◽

Abdominal Discomfort ◽

Irritable Bowel

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Adequate Relief as an Endpoint in Clinical Trials in Irritable Bowel Syndrome

Journal of International Medical Research ◽

10.1177/030006059802600203 ◽

1998 ◽

Vol 26 (2) ◽

pp. 76-81 ◽

Cited By ~ 68

Author(s):

AW Mangel ◽

BA Hahn ◽

AT Heath ◽

AR Northcutt ◽

S Kong ◽

...

Keyword(s):

Quality Of Life ◽

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Bowel Function ◽

Recurrent Abdominal Pain ◽

Response To Therapy ◽

Multiple Parameters ◽

Severity Scores ◽

Irritable Bowel

Irritable bowel syndrome is characterized by recurrent abdominal pain and altered bowel function. In designing studies to evaluate new treatments for this disease, however, it is difficult to select appropriate endpoints to reflect improvement in the range of symptoms of the syndrome. In the present study we evaluated the parameter of adequate relief of abdominal pain and discomfort, as perceived by the patients, as a key endpoint for efficacy in the treatment of patients with irritable bowel syndrome. Abdominal pain and bowel function data were collected daily from 370 patients with the disease during treatment with placebo or a novel potent 5HT3 receptor antagonist. Once every 7 days adequate relief of pain and discomfort was assessed. Quality-of-life data were collected using self-administered questionnaires. The endpoint of adequate relief was significantly ( P < 0.05) correlated with improvement in pain severity scores, percentage of pain-free days, percentage of days with urgency, improvement in stool frequency and consistency, and quality-of-life parameters. Adequate relief of pain and discomfort is significantly correlated with changes in multiple parameters associated with irritable bowel syndrome and can be used as an endpoint for assessing response to therapy in these patients.

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