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Emerging Pharmacologic Therapies for Irritable Bowel Syndrome

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Abstract

New therapies are being developed for irritable bowel syndrome (IBS). These advances are based on understanding pathophysiology or the development of medications with greater selectivity in classes of agents with known efficacy. Prucalopride, the newest European Medicines Agency-approved 5-hydroxytryptamine receptor 4 (5-HT4) agonist, is effective in the treatment of chronic constipation with improved cardiovascular safety relative to older 5-HT4 drugs; similarly, ramosetron, the 5-hydroxytryptamine receptor 3 (5-HT3) antagonist, appears efficacious in diarrhea-predominant IBS. Secretagogues with different mechanisms of action target apical domains in enterocytes that are involved in chloride secretion, such as chloride channels, the cystic fibrosis transmembrane regulator, and guanylate cyclase C. As a class, such secretagogues have high efficacy and safety for constipation. With more data obtained from phase 2 and 3 trials, we expect other classes of medications, including bile acid modulators, anti-inflammatory agents, visceral analgesics, and newer centrally acting agents to be efficacious and enter the armamentarium for the treatment of IBS in the future.

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Acknowledgments

We thank Mrs. Cindy Stanislav for her excellent secretarial support.

Disclosure

Dr. Camilleri has received research grants related to the subject matter of this article from Microbia, Theravance, and ARYx. He also serves as a consultant to Ironwood, ARYx, and Theravance, earning less than the federal threshold for significant financial conflict of interest as an aggregate from the three companies together. Dr. Camilleri has signed a confidentiality disclosure agreement with Movetis to have access to prucalopride data, but does not receive any financial remuneration. No other potential conflicts of interest relevant to this article were reported.

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Correspondence to Michael Camilleri.

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Manabe, N., Rao, A.S., Wong, B.S. et al. Emerging Pharmacologic Therapies for Irritable Bowel Syndrome. Curr Gastroenterol Rep 12, 408–416 (2010). https://doi.org/10.1007/s11894-010-0124-1

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