Dietary and pharmacological treatment of abdominal pain in IBS
Dietary and pharmacological treatment of abdominal pain in IBS
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DOI：
10.1136/gutjnl-2016-313425
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发表时间：
2017-05-01
期刊：
影响因子：
24.5
通讯作者：
Boeckxstaens, Guy
中科院分区：
文献类型：
--
作者：
Camilleri, Michael;Boeckxstaens, Guy
本文介绍了内脏感觉的原理，并对功能性胃肠道疾病(主要是肠易激综合征)内脏疼痛的治疗方法进行了评价。这些方法包括饮食措施，包括纤维补充剂、低可发酵寡糖、二糖、单糖和多元醇饮食，以及药理方法，如抗痉挛药、薄荷油、抗抑郁药(三环类药物、选择性5-羟色胺再摄取抑制剂)、5-HT3受体拮抗剂(阿洛司琼、恩丹西酮、雷莫司琼)、未被吸收的抗生素(利福昔明)、分泌剂(黄体酮、利奈卡肽)、类阿片受体(OR)和kappa-OR激动剂、组胺H1受体拮抗剂(依巴斯汀)、神经激动素-2受体拮抗剂(Iboduant)和伽巴比林能药(gabapentin和pregabalin)。有效性和安全性的讨论基于关键试验或已发表的系统评价和荟萃分析，表达OR或相对风险及其95%的CI。潜在的新方法可能基于对人类活检组织和内脏高敏感动物模型中的基因、microRNA和表观遗传标记的黏膜表达的最新见解。本文的目的是评估肠道感觉的生理学和解剖学，以及几种治疗方法在缓解内脏疼痛(典型的IBS)方面的疗效。这些包括可发酵低聚糖、双糖、单糖和多元醇(FODMAP)和不同类别的药物(方框1)。
This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT3 receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), mu-opioid receptor (OR) and kappa-OR agonist, delta-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and metaanalysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1).