title: Role of antispasmodics in the treatment of irritable bowel syndrome.
abstract: Irritable bowel syndrome (IBS) is a long-lasting, relapsing disorder characterized by abdominal pain/discomfort and altered bowel habits. Intestinal motility impairment and visceral hypersensitivity are the key factors among its multifactorial pathogenesis, both of which require effective treatment. Voltage-gated calcium channels mediate smooth muscle contraction and endocrine secretion and play important roles in neuronal transmission. Antispasmodics are a group of drugs that have been used in the treatment of IBS for decades. Alverine citrate, a spasmolytic, decreases the sensitivity of smooth muscle contractile proteins to calcium, and it is a selective 5-HT1A receptor antagonist. Alverine, in combination with simethicone, has been demonstrated to effectively reduce abdominal pain and discomfort in a large placebo-controlled trial. Mebeverine is a musculotropic agent that potently blocks intestinal peristalsis. Non-placebo-controlled trials have shown positive effects of mebeverine in IBS regarding symptom control; nevertheless, in recent placebo-controlled studies, mebeverine did not exhibit superiority over placebo. Otilonium bromide is poorly absorbed from the GI tract, where it acts locally as an L-type calcium channel blocker, an antimuscarinic and a tachykinin NK2 receptor antagonist. Otilonium has effectively reduced pain and improved defecation alterations in placebo-controlled trials in IBS patients. Pinaverium bromide is also an L-type calcium channel blocker that acts locally in the GI tract. Pinaverium improves motility disorders and consequently reduces stool problems in IBS patients. Phloroglucinol and trimethylphloroglucinol are non-specific antispasmodics that reduced pain in IBS patients in a placebo-controlled trial. Antispasmodics have excellent safety profiles. T-type calcium channel blockers can abolish visceral hypersensitivity in animal models, which makes them potential candidates for the development of novel therapeutic agents in the treatment of IBS.
authors.affiliation: Anita Annaházi, Richárd Róka, András Rosztóczy, Tibor Wittmann, First Department of Medicine, University of Szeged, 6720 Szeged, Hungary.
authors.forename: Anita
authors.initials: A
authors.lastname: Annaházi
authors.affiliation: Anita Annaházi, Richárd Róka, András Rosztóczy, Tibor Wittmann, First Department of Medicine, University of Szeged, 6720 Szeged, Hungary.
authors.forename: Richárd
authors.initials: R
authors.lastname: Róka
authors.affiliation: Anita Annaházi, Richárd Róka, András Rosztóczy, Tibor Wittmann, First Department of Medicine, University of Szeged, 6720 Szeged, Hungary.
authors.forename: András
authors.initials: A
authors.lastname: Rosztóczy
authors.affiliation: Anita Annaházi, Richárd Róka, András Rosztóczy, Tibor Wittmann, First Department of Medicine, University of Szeged, 6720 Szeged, Hungary.
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000818:Animals; D002118:Calcium / Q000737:chemistry; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015220:Calcium Channels / Q000378:metabolism; D004195:Disease Models, Animal; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy*; D009025:Morpholines / Q000627:therapeutic use; D010276:Parasympatholytics / Q000627:therapeutic use*; D010627:Phenethylamines / Q000627:therapeutic use; D000644:Quaternary Ammonium Compounds / Q000737:chemistry; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D015220:Calcium Channels; D009025:Morpholines; D010276:Parasympatholytics; D010627:Phenethylamines; D000644:Quaternary Ammonium Compounds; C013934:octylonium; C005096:mebeverine; D002118:Calcium; C013199:pinaverium
keywords: Calcium channel blockers; Irritable bowel syndrome; Motility; Spasmolytics; Treatment