Expert review of gastroenterology & hepatology
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Expert Rev Gastroenterol Hepatol · Jul 2013
ReviewManagement of irritable bowel syndrome with constipation: a flexible approach to treating a complex condition with multiple symptoms.
Irritable bowel syndrome is a heterogeneous disease with a complex underlying pathophysiology and multiple symptoms - that is, clinical manifestation patterns. As such, management of irritable bowel syndrome requires a flexible approach tailored to the individual patient. This article reviews rational, evidence-based management strategy and treatment options for this variable condition.
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Expert Rev Gastroenterol Hepatol · Jul 2013
ReviewEmerging receptor target in the pharmacotherapy of irritable bowel syndrome with constipation.
Preclinical experiments in rodent models have recently provided new information on the mechanisms underlying pain sensation in chronic visceral hypersensitivity, as well as insights into the mechanism of action of new drugs targeting abdominal pain in irritable bowel syndrome (IBS). This article describes the evidence base supporting the role of guanylate cyclase C (GC-C) activation in the modulation of gastrointestinal transit and, in particular, in visceral hypersensitivity. We propose that GC-C activation represents an important emerging target for pharmacotherapy in IBS with constipation (IBS-C), particularly given the recent regulatory approval of the GC-C agonist linaclotide as a treatment for IBS-C. More specifically, we address the following questions: "How is pain transmitted from the colon?"; "How is abdominal pain increased in IBS-C?"; "How can we reduce IBS-related abdominal pain - what drugs have been developed?"; "Does linaclotide reduce abdominal pain in animals and humans?"; and "How does linaclotide reduce abdominal pain?".
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Expert Rev Gastroenterol Hepatol · Jul 2013
ReviewHow can we achieve relief of bowel and abdominal symptoms for patients with irritable bowel syndrome with constipation?
Current interventions for irritable bowel syndrome with constipation tend to target single symptoms of the disorder, with multiple symptom relief only achieved through the use of combinations of therapies. Hence, there remains an unmet need for well-tolerated and effective treatments for irritable bowel syndrome with constipation that target abdominal symptoms, including abdominal pain and bowel symptoms.
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Expert Rev Gastroenterol Hepatol · Jan 2013
ReviewMethylnaltrexone for the treatment of opioid-induced constipation.
Opioids are the drugs of choice for treating moderate-to-severe pain, especially for patients in the end stage of cancer or other advanced illnesses, and also in critical care or for the treatment of chronic pain. Side effects such as nausea, pruritus, dizziness and constipation have to be controlled in order to use these drugs to their full potential. ⋯ It is licensed for the treatment of opioid-induced constipation in palliative care in more than 50 countries. This article presents practically relevant pharmacological data, basic research results and evidence from clinical research about methylnaltrexone, and outlines potential future therapeutic options for this promising drug.