Treatment of irritable bowel syndrome: the past, present and future

Abstract

The aim of review. To present data on foreign and Russian clinical studies devoted to improvement of irritable bowel syndrome (IBS) treatment according to the new data on disease pathogenesis.Summary. Spasmolytics, laxatives or antidiarrheal agents are traditionally applied for treatment of IBS patients according to leading symptom. Considering new data on IBS pathogenesis (disorder of intestinal microbiome, functional and structural remodeling of proteins of cell membrane at the level of synapses of spinal cord posterior horns), prescription of probiotics and peripheral opioid receptors agonists is proven as well. Number of studies, devoted to probiotics efficacy evaluation, is constantly increasing. As a whole, the majority of systematic reviews and metaanalyses draw a conclusion of high efficacy and safety of specified group of drugs at IBS. Agonists of peripheral opioid receptors normalize motility of gastro-intestinal tract and increase a threshold of pain sensitivity mediated by glutamate synaptic receptors of spinal cord posterior horns that prevents development of central and peripheral sensitization. Efficacy of this drug group in IBS patients, also is considered to be proven.Conclusion. Prescription of probiotics, peripheral opioid receptor agonists at IBS is pathogenicly proven and allows to increase treatment efficacy significantly.

Keywords

• probiotics
• bacterial overgrowth syndrome
• opioid receptors
• opioid receptor agonists