HCPLive Network

Choosing Effective Pharmacologic and Nonpharmacologic Approaches to Irritable Bowel Syndrome Treatment

 
Noting that the “complicated pathophysiology” of irritable bowel syndrome (IBS) and the lack of effective drugs that satisfactorily treat the symptoms of IBS means there is high demand for new therapeutic agents for this condition, the authors of “Metabolic and Toxicological Considerations for the Latest Drugs Used to Treat Irritable Bowel Syndrome,” published in Expert Opinion on Drug Metabolism & Toxicology, conducted a systematic review of the literature to provide an update “on new clinically introduced drugs for IBS and their dynamics and kinetics data.”
 
Among their findings:
  • Some drugs, such as ramosetron (a 5-HT3 antagonist) and pexacerfont (a CRF1 receptor antagonist), have “shown some benefits in diarrhea-predominant IBS (D-IBS”
  • Prucalopride and mosapride (5-HT4 agonists) with prokinetic effect “were found useful in constipation-predominant IBS (C-IBS)”
  • Dexloxiglumide, lubiprostone and linaclotide “have shown beneficial effects in C-IBS patients”
  • Melatonin regulates GI tract motility and asimadoline, gabapentin and pregabalin “show reduction of pain threshold and visceral hypersensitivity”
  • Glucagon-like peptide analog, calcium-channel blockers, and neurokinin receptor antagonists have shown some benefit in treating pain associated with IBS
 
The authors wrote that “More time is required to indicate both efficacy and safety in long-term treatment due to multifactorial pathophysiology, variations in individual responses and insufficient assessment methods, which limit the right decision-making process about the efficacy and tolerability of these new drugs.”
 
While researchers continue to look for new and novel pharmacologic therapies for IBS, others have focused on nonpharmacologic approaches such as hypnotherapy and cognitive behavioral therapy (CBT). One recent study by Labus and colleagues looked at whether “a short course of group psycho-educational treatment consisting of combined CBT and basic relaxation techniques result in sustained, clinically relevant improvement of IBS symptom severity and health-related quality of life.” The researchers also attempted to identify “the factors that predict a positive outcome (moderators), and the factors that mediate the positive outcomes of the intervention.”
 
Although the authors reported that “patients who participated in the psycho-education classes improved on all key measures by the end of the intervention, and demonstrated lower overall symptom severity ratings than those in the control group,” it was unclear which specific aspect of therapy was most responsible for producing these outcomes.
 
This was underscored in a recent commentary in Alimentary Pharmacology and Therapeutics. The author noted that although the study of psycho-educational therapy for IBS was “the first attempt to subject what they describe as a psycho-educational intervention to the rigours of modern clinical research methodology,” and supported previous research that found “positive physician-patient interaction” and patient education improved symptoms and reduced physician visits, the study “cannot tell us is why their approach worked and, specifically, which of the elements of the programme was most beneficial.”
 
Pragmatically, the author wrote that “determining the operative element(s) of the strategy employed by Labus and colleagues is of practical, as well as academic, interest; this information will be critical when one attempts to find support for such a programme, be it from a hospital, an academic institution or a payor.”
 

Further Reading
The FDA has approved Baxter’s Rixubis [Coagulation Factor IX (Recombinant)], an intravenous prophylactic treatment intended to control and prevent bleeding episodes and assist with perioperative management for children 12 years and younger with hemophilia B.
A compound known as P7C3-S243 appears to keep axons from degenerating after a blast injury, a University of Iowa mouse study has found. “We propose that P7C3-S243 serves as a chemical scaffold upon which new drugs can be designed to treat patients with condition of axonal degradation such as occurs in traumatic brain injury or other neurodegenerative disease,” the researchers wrote
Researchers have long known that the risk for schizophrenia is inherited. In new findings published online Sept 15 in The American Journal of Psychiatry, senior investigator C. Robert Cloninger, MD, PhD, of the Washington University School of Medicine in St. Louis, MO, said his team identified distinct gene clusters that contribute to 8 different classes of the disease.
Nancy Chiaravalloti, PhD, shares how cognitive function impacts patients with progressive multiple sclerosis at the 2014 Joint ACTRIMS-ECTRIMS Meeting in Boston.
A new set of guidelines from the American College of Physicians (ACP) advises physicians to prescribe exercises and behavioral therapy—not drugs—as first-line treatment for many patients with urinary incontinence (UI).
Using an experimental and highly sensitive test for cardiac troponin, a team of Johns Hopkins researchers found undetected signs of heart muscle damage in people with diabetes and pre-diabetes. That may suggest that hypoglycemia directly damages the heart.
As reported in the EMBO Molecular Medicine journal, researchers have discovered there are several types of dendritic cells within human skin that play a role in both the earlier and more advances stages of psoriasis.
More Reading