title: Constipation-predominant irritable bowel syndrome: a review of current and emerging drug therapies.
abstract: Irritable bowel syndrome (IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS (IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.
authors.affiliation: Khaled A Jadallah, Susan M Kullab, Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Jadallah
authors.affiliation: Khaled A Jadallah, Susan M Kullab, Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kullab
authors.affiliation: Khaled A Jadallah, Susan M Kullab, Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000818:Animals; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D003672:Defecation / Q000187:drug effects; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000503:physiopathology; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D054368:Laxatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D002756:Cholagogues and Choleretics; D005765:Gastrointestinal Agents; D054368:Laxatives
keywords: 5-hydroxytryptamine type 4 agonists; Bile acid modulators; Constipation; Drug therapy; Irritable bowel syndrome; Prokinetics; Prosecretory agents; Secretagogues; Serotonergic agents
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