Anesthesiology and Pain Medicine

Published by: Kowsar

Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article

Longtu Chen 1 , Sheikh J. Ilham 1 and Bin Feng 1 , *
Authors Information
1 Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
Article information
  • Anesthesiology and Pain Medicine: April 2017, 7 (2); e42747
  • Published Online: January 25, 2017
  • Article Type: Review Article
  • Received: October 3, 2016
  • Revised: December 2, 2016
  • Accepted: December 24, 2016
  • DOI: 10.5812/aapm.42747

To Cite: Chen L, Ilham S J, Feng B. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article, Anesth Pain Med. 2017 ; 7(2):e42747. doi: 10.5812/aapm.42747.

Abstract
Copyright © 2017, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Introduction
2. Conventional Pain Managing Drugs Adopted For The Viscera
3. Peripherally Restricted Drugs For Managing Visceral Pain
4. Serotonergic Agonist/Antagonist
5. Peripherally Restricted Opioids
6. Chloride Channel Activator
7. Guanylate Clyclase-C (GC-C) Agonist
8. Promising Novel Targets and Drugs For Ibs Pain
9. Conclusions
Acknowledgements
Footnote
References
  • 1. Nusrat S, Miner PJ. New pharmacological treatment options for irritable bowel syndrome with constipation. Expert Opin Emerg Drugs. 2015; 20(4): 625-36[DOI][PubMed]
  • 2. Furnari M, de Bortoli N, Martinucci I, Bodini G, Revelli M, Marabotto E, et al. Optimal management of constipation associated with irritable bowel syndrome. Ther Clin Risk Manag. 2015; 11: 691-703[DOI][PubMed]
  • 3. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006; 130(5): 1480-91[DOI][PubMed]
  • 4. Feng B, La JH, Schwartz ES, Gebhart GF. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Neural and neuro-immune mechanisms of visceral hypersensitivity in irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2012; 302(10)-98[DOI][PubMed]
  • 5. Engsbro AL, Simren M, Bytzer P. The Rome II and Rome III criteria identify the same subtype-populations in irritable bowel syndrome: agreement depends on the method used for symptom report. Neurogastroenterol Motil. 2012; 24(7): 604-11[DOI][PubMed]
  • 6. Palsson OS, Whitehead WE, van Tilburg MA, Chang L, Chey W, Crowell MD, et al. Rome IV Diagnostic Questionnaires and Tables for Investigators and Clinicians. Gastroenterology. 2016; [DOI][PubMed]
  • 7. Videlock EJ, Adeyemo M, Licudine A, Hirano M, Ohning G, Mayer M, et al. Childhood trauma is associated with hypothalamic-pituitary-adrenal axis responsiveness in irritable bowel syndrome. Gastroenterology. 2009; 137(6): 1954-62[DOI][PubMed]
  • 8. Chitkara DK, van Tilburg MA, Blois-Martin N, Whitehead WE. Early life risk factors that contribute to irritable bowel syndrome in adults: a systematic review. Am J Gastroenterol. 2008; 103(3): 765-74[DOI][PubMed]
  • 9. North CS, Hong BA, Alpers DH. Relationship of functional gastrointestinal disorders and psychiatric disorders: implications for treatment. World J Gastroenterol. 2007; 13(14): 2020-7[PubMed]
  • 10. Saito YA, Talley NJ. Genetics of irritable bowel syndrome. Am J Gastroenterol. 2008; 103(8): 2100-4[DOI][PubMed]
  • 11. Fukudo S, Kanazawa M. Gene, environment, and brain-gut interactions in irritable bowel syndrome. J Gastroenterol Hepatol. 2011; 26 Suppl 3: 110-5[DOI][PubMed]
  • 12. Marynowski M, Likonska A, Zatorski H, Fichna J. Role of environmental pollution in irritable bowel syndrome. World J Gastroenterol. 2015; 21(40): 11371-8[DOI][PubMed]
  • 13. Schwille-Kiuntke J, Mazurak N, Enck P. Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers' diarrhoea. Aliment Pharmacol Ther. 2015; 41(11): 1029-37[DOI][PubMed]
  • 14. Piche T. Tight junctions and IBS--the link between epithelial permeability, low-grade inflammation, and symptom generation? Neurogastroenterol Motil. 2014; 26(3): 296-302[DOI][PubMed]
  • 15. Collins SM. A role for the gut microbiota in IBS. Nat Rev Gastroenterol Hepatol. 2014; 11(8): 497-505[DOI][PubMed]
  • 16. Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011; 62: 381-96[DOI][PubMed]
  • 17. Price DD, Zhou Q, Moshiree B, Robinson ME, Verne GN. Peripheral and central contributions to hyperalgesia in irritable bowel syndrome. J Pain. 2006; 7(8): 529-35[DOI][PubMed]
  • 18. Feng B, La JH, Schwartz ES, Tanaka T, McMurray TP, Gebhart GF. Long-term sensitization of mechanosensitive and -insensitive afferents in mice with persistent colorectal hypersensitivity. Am J Physiol Gastrointest Liver Physiol. 2012; 302(7)-83[DOI][PubMed]
  • 19. Feng B, La JH, Tanaka T, Schwartz ES, McMurray TP, Gebhart GF. Altered colorectal afferent function associated with TNBS-induced visceral hypersensitivity in mice. Am J Physiol Gastrointest Liver Physiol. 2012; 303(7)-24[DOI][PubMed]
  • 20. Zhou Q, Price DD, Verne GN. Reversal of visceral and somatic hypersensitivity in a subset of hypersensitive rats by intracolonic lidocaine. Pain. 2008; 139(1): 218-24[DOI][PubMed]
  • 21. Verne GN, Robinson ME, Vase L, Price DD. Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients. Pain. 2003; 105(1-2): 223-30[PubMed]
  • 22. Verne GN, Sen A, Price DD. Intrarectal lidocaine is an effective treatment for abdominal pain associated with diarrhea-predominant irritable bowel syndrome. J Pain. 2005; 6(8): 493-6[DOI][PubMed]
  • 23. Louvel D, Delvaux M, Staumont G, Camman F, Fioramonti J, Bueno L, et al. Intracolonic injection of glycerol: a model for abdominal pain in irritable bowel syndrome? Gastroenterology. 1996; 110(2): 351-61[PubMed]
  • 24. Al-Chaer ED. Neuroanatomy of Visceral Pain. Chronic abdominal and visceral pain: Theory and practice . 2007;
  • 25. Locke G3, Zinsmeister AR, Talley NJ, Fett SL, Melton LJ. Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities. Am J Gastroenterol. 2000; 95(1): 157-65[DOI][PubMed]
  • 26. Keszthelyi D, Dackus GH, Masclee GM, Kruimel JW, Masclee AA. Increased proton pump inhibitor and NSAID exposure in irritable bowel syndrome: results from a case-control study. BMC Gastroenterol. 2012; 12: 121[DOI][PubMed]
  • 27. Kerckhoffs AP, Akkermans LM, de Smet MB, Besselink MG, Hietbrink F, Bartelink IH, et al. Intestinal permeability in irritable bowel syndrome patients: effects of NSAIDs. Dig Dis Sci. 2010; 55(3): 716-23[DOI][PubMed]
  • 28. Thiefin G, Beaugerie L. Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum. Joint Bone Spine. 2005; 72(4): 286-94[DOI][PubMed]
  • 29. Higuchi K, Umegaki E, Watanabe T, Yoda Y, Morita E, Murano M, et al. Present status and strategy of NSAIDs-induced small bowel injury. J Gastroenterol. 2009; 44(9): 879-88[DOI][PubMed]
  • 30. Hinson JA, Roberts DW, James LP. Mechanisms of acetaminophen-induced liver necrosis. Handb Exp Pharmacol. 2010; (196): 369-405[DOI][PubMed]
  • 31. Soleimanpour M, Imani F, Safari S, Sanaie S, Soleimanpour H, Ameli H, et al. The Role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Treatment of Patients With Hepatic Disease: A Review Article. Anesth Pain Med. 2016; 6(4)[DOI][PubMed]
  • 32. Szigethy E, Schwartz M, Drossman D. Narcotic bowel syndrome and opioid-induced constipation. Curr Gastroenterol Rep. 2014; 16(10): 410[DOI][PubMed]
  • 33. Drossman D, Szigethy E. The narcotic bowel syndrome: a recent update. Am J Gastroenterol Suppl. 2014; 2(1): 22-30[DOI][PubMed]
  • 34. Munro G, Hansen RR, Mirza NR. GABA(A) receptor modulation: potential to deliver novel pain medicines? Eur J Pharmacol. 2013; 716(1-3): 17-23[DOI][PubMed]
  • 35. Lader M. Effectiveness of benzodiazepines: do they work or not? Expert Rev Neurother. 2008; 8(8): 1189-91[DOI][PubMed]
  • 36. Salari P, Abdollahi M. Systematic review of modulators of benzodiazepine receptors in irritable bowel syndrome: is there hope? World J Gastroenterol. 2011; 17(38): 4251-7[DOI][PubMed]
  • 37. Leventer SM, Raudibaugh K, Frissora CL, Kassem N, Keogh JC, Phillips J, et al. Clinical trial: dextofisopam in the treatment of patients with diarrhoea-predominant or alternating irritable bowel syndrome. Aliment Pharmacol Ther. 2008; 27(2): 197-206[DOI][PubMed]
  • 38. Rahimi R, Nikfar S, Rezaie A, Abdollahi M. Efficacy of tricyclic antidepressants in irritable bowel syndrome: a meta-analysis. World J Gastroenterol. 2009; 15(13): 1548-53[PubMed]
  • 39. Xie C, Tang Y, Wang Y, Yu T, Wang Y, Jiang L, et al. Efficacy and Safety of Antidepressants for the Treatment of Irritable Bowel Syndrome: A Meta-Analysis. PLoS One. 2015; 10(8)[DOI][PubMed]
  • 40. Vahedi H, Merat S, Rashidioon A, Ghoddoosi A, Malekzadeh R. The effect of fluoxetine in patients with pain and constipation-predominant irritable bowel syndrome: a double-blind randomized-controlled study. Aliment Pharmacol Ther. 2005; 22(5): 381-5[DOI][PubMed]
  • 41. Kuiken SD, Tytgat GN, Boeckxstaens GE. The selective serotonin reuptake inhibitor fluoxetine does not change rectal sensitivity and symptoms in patients with irritable bowel syndrome: a double blind, randomized, placebo-controlled study. Clin Gastroenterol Hepatol. 2003; 1(3): 219-28[DOI][PubMed]
  • 42. Tack J, Broekaert D, Fischler B, Van Oudenhove L, Gevers AM, Janssens J. A controlled crossover study of the selective serotonin reuptake inhibitor citalopram in irritable bowel syndrome. Gut. 2006; 55(8): 1095-103[DOI][PubMed]
  • 43. Talley NJ, Kellow JE, Boyce P, Tennant C, Huskic S, Jones M. Antidepressant therapy (imipramine and citalopram) for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial. Dig Dis Sci. 2008; 53(1): 108-15[DOI][PubMed]
  • 44. Ladabaum U, Sharabidze A, Levin TR, Zhao WK, Chung E, Bacchetti P, et al. Citalopram provides little or no benefit in nondepressed patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2010; 8(1): 42-48 e1[DOI][PubMed]
  • 45. Tabas G, Beaves M, Wang J, Friday P, Mardini H, Arnold G. Paroxetine to treat irritable bowel syndrome not responding to high-fiber diet: a double-blind, placebo-controlled trial. Am J Gastroenterol. 2004; 99(5): 914-20[DOI][PubMed]
  • 46. Camilleri M, Busciglio I, Carlson P, McKinzie S, Burton D, Baxter K, et al. Pharmacogenetics of low dose clonidine in irritable bowel syndrome. Neurogastroenterol Motil. 2009; 21(4): 399-410[DOI][PubMed]
  • 47. Viramontes BE, Malcolm A, Camilleri M, Szarka LA, McKinzie S, Burton DD, et al. Effects of an alpha(2)-adrenergic agonist on gastrointestinal transit, colonic motility, and sensation in humans. Am J Physiol Gastrointest Liver Physiol. 2001; 281(6)-76[PubMed]
  • 48. Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015; 90(4): 532-45[DOI][PubMed]
  • 49. Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesth Pain Med. 2012; 2(2): 52-3[DOI][PubMed]
  • 50. Lee KJ, Kim JH, Cho SW. Gabapentin reduces rectal mechanosensitivity and increases rectal compliance in patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2005; 22(10): 981-8[DOI][PubMed]
  • 51. Houghton LA, Fell C, Whorwell PJ, Jones I, Sudworth DP, Gale JD. Effect of a second-generation alpha2delta ligand (pregabalin) on visceral sensation in hypersensitive patients with irritable bowel syndrome. Gut. 2007; 56(9): 1218-25[DOI][PubMed]
  • 52. Gold MS, Gebhart GF. Nociceptor sensitization in pain pathogenesis. Nat Med. 2010; 16(11): 1248-57[DOI][PubMed]
  • 53. Wultsch T, Painsipp E, Shahbazian A, Mitrovic M, Edelsbrunner M, Lazdunski M, et al. Deletion of the acid-sensing ion channel ASIC3 prevents gastritis-induced acid hyperresponsiveness of the stomach-brainstem axis. Pain. 2008; 134(3): 245-53[DOI][PubMed]
  • 54. Manning DD, Guo C, Zhang Z, Ryan KN, Naginskaya J, Choo SH, et al. The discovery of diazepinone-based 5-HT3 receptor partial agonists. Bioorg Med Chem Lett. 2014; 24(11): 2578-81[DOI][PubMed]
  • 55. Gilet M, Eutamene H, Han H, Kim HW, Bueno L. Influence of a new 5-HT4 receptor partial agonist, YKP10811, on visceral hypersensitivity in rats triggered by stress and inflammation. Neurogastroenterol Motil. 2014; 26(12): 1761-70[DOI][PubMed]
  • 56. Cremon C, Carini G, Wang B, Vasina V, Cogliandro RF, De Giorgio R, et al. Intestinal serotonin release, sensory neuron activation, and abdominal pain in irritable bowel syndrome. Am J Gastroenterol. 2011; 106(7): 1290-8[DOI][PubMed]
  • 57. Moore NA, Sargent BJ, Manning DD, Guzzo PR. Partial agonism of 5-HT3 receptors: a novel approach to the symptomatic treatment of IBS-D. ACS Chem Neurosci. 2013; 4(1): 43-7[DOI][PubMed]
  • 58. Cash BD, Lacy BE, Rao T, Earnest DL. Rifaximin and eluxadoline - newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron? Expert Opin Pharmacother. 2016; 17(3): 311-22[DOI][PubMed]
  • 59. Gershon MD, Tack J. The serotonin signaling system: from basic understanding to drug development for functional GI disorders. Gastroenterology. 2007; 132(1): 397-414[DOI][PubMed]
  • 60. Goldberg PA, Kamm MA, Setti-Carraro P, van der Sijp JR, Roth C. Modification of visceral sensitivity and pain in irritable bowel syndrome by 5-HT3 antagonism (ondansetron). Digestion. 1996; 57(6): 478-83[PubMed]
  • 61. Garsed K, Chernova J, Hastings M, Lam C, Marciani L, Singh G, et al. A randomised trial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut. 2014; 63(10): 1617-25[DOI][PubMed]
  • 62. Scarpellini E, Laterza L, Ianiro G, Tack J, Abenavoli L, Gasbarrini A. Eluxadoline for the treatment of diarrhoea-predominant irritable bowel syndrome. Expert Opin Pharmacother. 2016; 17(10): 1395-402[DOI][PubMed]
  • 63. Lacy BE. Emerging treatments in neurogastroenterology: eluxadoline - a new therapeutic option for diarrhea-predominant IBS. Neurogastroenterol Motil. 2016; 28(1): 26-35[DOI][PubMed]
  • 64. Lavo B, Stenstam M, Nielsen AL. Loperamide in treatment of irritable bowel syndrome--a double-blind placebo controlled study. Scand J Gastroenterol Suppl. 1987; 130: 77-80[PubMed]
  • 65. Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol. 1996; 31(5): 463-8[DOI][PubMed]
  • 66. Cann PA, Read NW, Holdsworth CD, Barends D. Role of loperamide and placebo in management of irritable bowel syndrome (IBS). Dig Dis Sci. 1984; 29(3): 239-47[PubMed]
  • 67. Wade PR, Palmer JM, McKenney S, Kenigs V, Chevalier K, Moore BA, et al. Modulation of gastrointestinal function by MuDelta, a mixed micro opioid receptor agonist/ micro opioid receptor antagonist. Br J Pharmacol. 2012; 167(5): 1111-25[DOI][PubMed]
  • 68. Sobolewska-Wlodarczyk A, Wlodarczyk M, Storr M, Fichna J. Clinical potential of eluxadoline in the treatment of diarrhea-predominant irritable bowel syndrome. Ther Clin Risk Manag. 2016; 12: 771-5[DOI][PubMed]
  • 69. Lembo AJ, Lacy BE, Zuckerman MJ, Schey R, Dove LS, Andrae DA, et al. Eluxadoline for Irritable Bowel Syndrome with Diarrhea. N Engl J Med. 2016; 374(3): 242-53[DOI][PubMed]
  • 70. Wall GC, Bryant GA, Bottenberg MM, Maki ED, Miesner AR. Irritable bowel syndrome: a concise review of current treatment concepts. World J Gastroenterol. 2014; 20(27): 8796-806[DOI][PubMed]
  • 71. Thomas RH, Luthin DR. Current and emerging treatments for irritable bowel syndrome with constipation and chronic idiopathic constipation: focus on prosecretory agents. Pharmacotherapy. 2015; 35(6): 613-30[DOI][PubMed]
  • 72. Rao S, Weber HC. New treatment targets for the management of irritable bowel syndrome. Curr Opin Endocrinol Diabetes Obes. 2014; 21(1): 9-14[DOI][PubMed]
  • 73. Corsetti M, Whorwell P. Novel pharmacological therapies for irritable bowel syndrome. Expert Rev Gastroenterol Hepatol. 2016; 10(7): 807-15[DOI][PubMed]
  • 74. Mozaffari S, Nikfar S, Abdollahi M. The safety of novel drugs used to treat irritable bowel syndrome. Expert Opin Drug Saf. 2014; 13(5): 625-38[DOI][PubMed]
  • 75. Jiang C, Xu Q, Wen X, Sun H. Current developments in pharmacological therapeutics for chronic constipation. Acta Pharm Sin B. 2015; 5(4): 300-9[DOI][PubMed]
  • 76. Drossman DA, Chey WD, Johanson JF, Fass R, Scott C, Panas R, et al. Clinical trial: lubiprostone in patients with constipation-associated irritable bowel syndrome--results of two randomized, placebo-controlled studies. Aliment Pharmacol Ther. 2009; 29(3): 329-41[DOI][PubMed]
  • 77. Feng B, Kiyatkin ME, La JH, Ge P, Solinga R, Silos-Santiago I, et al. Activation of guanylate cyclase-C attenuates stretch responses and sensitization of mouse colorectal afferents. J Neurosci. 2013; 33(23): 9831-9[DOI][PubMed]
  • 78. Tack J, Vanuytsel T, Corsetti M. Modern Management of Irritable Bowel Syndrome: More Than Motility. Dig Dis. 2016; 34(5): 566-73[DOI][PubMed]
  • 79. Rao S, Lembo AJ, Shiff SJ, Lavins BJ, Currie MG, Jia XD, et al. A 12-week, randomized, controlled trial with a 4-week randomized withdrawal period to evaluate the efficacy and safety of linaclotide in irritable bowel syndrome with constipation. Am J Gastroenterol. 2012; 107(11): 1714-24[DOI][PubMed]
  • 80. Chey WD, Lembo AJ, Lavins BJ, Shiff SJ, Kurtz CB, Currie MG, et al. Linaclotide for irritable bowel syndrome with constipation: a 26-week, randomized, double-blind, placebo-controlled trial to evaluate efficacy and safety. Am J Gastroenterol. 2012; 107(11): 1702-12[DOI][PubMed]
  • 81. Feng B, Zhu Y, La JH, Wills ZP, Gebhart GF. Experimental and computational evidence for an essential role of NaV1.6 in spike initiation at stretch-sensitive colorectal afferent endings. J Neurophysiol. 2015; 113(7): 2618-34[DOI][PubMed]
  • 82. Ness TJ, Metcalf AM, Gebhart GF. A psychophysiological study in humans using phasic colonic distension as a noxious visceral stimulus. Pain. 1990; 43(3): 377-86[PubMed]
  • 83. Osteen JD, Herzig V, Gilchrist J, Emrick JJ, Zhang C, Wang X, et al. Selective spider toxins reveal a role for the Nav1.1 channel in mechanical pain. Nature. 2016; 534(7608): 494-9[DOI][PubMed]
  • 84. Castro J, Harrington AM, Garcia-Caraballo S, Maddern J, Grundy L, Zhang J, et al. alpha-Conotoxin Vc1.1 inhibits human dorsal root ganglion neuroexcitability and mouse colonic nociception via GABAB receptors. Gut. 2016; [DOI][PubMed]
  • 85. Lembo A. Peripheral opioids for functional GI disease: a reappraisal. Dig Dis. 2006; 24(1-2): 91-8[DOI][PubMed]
  • 86. Mangel AW, Williams VS. Asimadoline in the treatment of irritable bowel syndrome. Expert Opin Investig Drugs. 2010; 19(10): 1257-64[DOI][PubMed]
  • 87. Camilleri M. Novel pharmacology: asimadoline, a kappa-opioid agonist, and visceral sensation. Neurogastroenterol Motil. 2008; 20(9): 971-9[DOI][PubMed]
  • 88. Menees SB, Maneerattannaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2012; 107(1): 28-35[DOI][PubMed]
  • 89. Corinaldesi R, Stanghellini V, Cremon C, Gargano L, Cogliandro RF, De Giorgio R, et al. Effect of mesalazine on mucosal immune biomarkers in irritable bowel syndrome: a randomized controlled proof-of-concept study. Aliment Pharmacol Ther. 2009; 30(3): 245-52[DOI][PubMed]
  • 90. Andrews CN, Griffiths TA, Kaufman J, Vergnolle N, Surette MG, Rioux KP. Mesalazine (5-aminosalicylic acid) alters faecal bacterial profiles, but not mucosal proteolytic activity in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2011; 34(3): 374-83[DOI][PubMed]
  • 91. Dorofeyev AE, Kiriyan EA, Vasilenko IV, Rassokhina OA, Elin AF. Clinical, endoscopical and morphological efficacy of mesalazine in patients with irritable bowel syndrome. Clin Exp Gastroenterol. 2011; 4: 141-53[DOI][PubMed]
  • 92. Tuteja AK, Fang JC, Al-Suqi M, Stoddard GJ, Hale DC. Double-blind placebo-controlled study of mesalamine in post-infective irritable bowel syndrome--a pilot study. Scand J Gastroenterol. 2012; 47(10): 1159-64[DOI][PubMed]
  • 93. Gay J, Ressayre L, Garcia-Villar R, Bueno L, Fioramonti J. Alteration of CCK-induced satiety in post-Nippostrongylus brasiliensis-infected rats. Brain Behav Immun. 2003; 17(1): 35-42[PubMed]
  • 94. Klooker TK, Braak B, Koopman KE, Welting O, Wouters MM, van der Heide S, et al. The mast cell stabiliser ketotifen decreases visceral hypersensitivity and improves intestinal symptoms in patients with irritable bowel syndrome. Gut. 2010; 59(9): 1213-21[DOI][PubMed]
  • 95. Leri O, Tubili S, De Rosa FG, Addessi MA, Scopelliti G, Lucenti W, et al. Management of diarrhoeic type of irritable bowel syndrome with exclusion diet and disodium cromoglycate. Inflammopharmacology. 1997; 5(2): 153-8[DOI][PubMed]
  • 96. Lobo B, Vicario M, Martinez C, Ramos L, Alonso C, Guilarte M, et al. 156 Clinical Benefit in IBS After Disodium Cromoglycate Involves Mast Cell-Mediated Recovery of Healthy-Like Innate Immunity Genes Expression Profile in the Jejunal Mucosa. Gastroenterology. 2009; 136(5)-30[DOI]
  • 97. Lobo B, Vicario M, Martinez C, Gonzalez-Castro AM, Ramos L, Alonso C, et al. Clinical improvement in IBS after disodium cromoglycate involves mast cell-mediated toll-like receptor signaling downregulation. Gastroenterology. 2011; 140(5)-499-S-500
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:

Author(s):

Article(s):

Create Citiation Alert
via Google Reader

Readers' Comments