title: Current and future pharmacological treatments for diarrhea-predominant irritable bowel syndrome.
abstract: BACKGROUND
  Diarrhea-predominant irritable bowel syndrome (IBS-D) affects about one-third of patients with IBS, which is observed in about 12% of people across five continents. The ultimate goal in this field is to identify the underlying cause of symptoms in order to individualize education of the patient, and to provide optimal treatment of this highly prevalent condition.
  
  
  METHODS
  This review addresses the pharmacological treatments for IBS-D under three categories: drugs for IBS-D (i.e., the 5-HT3 antagonist, alosetron); drugs approved for other indications that are used in IBS-D (e.g., opioid agonists; other 5-HT3 antagonists; serotonergic psychoactive agents; bile acid binders; 5-ASA compounds; probiotics and non-absorbable antibiotics); as well as development of drugs that are likely to impact the management of IBS-D in the future (e.g., drug absorbents; TPH1 inhibitors; mast cell stabilizers; centrally acting benzodiazepines). The final section addresses key findings: regulatory roadblocks; weaknesses in the current research in this field so far and opportunities to address unmet needs including restoration of normal intestinal barrier function or permeability, and suppression within the intestines of local immune activation that is thought to trigger abnormal motor, sensory and secretory functions in IBS-D.
  
  
  CONCLUSIONS
  While symptomatic treatment of diarrhea is effective, there is a need for new treatments for the IBS-D complex. Greater understanding of the mechanisms in IBS-D has led to promising approaches to develop more efficacious therapies.
authors.affiliation: Mayo Clinic, Clinical Enteric Neuroscience Translational and Epidemiological Research, Charlton 8-110, 200 First St. S.W., Rochester, 55905 MN, USA. camilleri.michael@mayo.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Camilleri
mesh_terms: D000818:Animals; D000930:Antidiarrheals / Q000627:therapeutic use; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D015195:Drug Design; D005765:Gastrointestinal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006301:Health Services Needs and Demand; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods
chemical_list: D000930:Antidiarrheals; D005765:Gastrointestinal Agents