New developments in the treatment of irritable bowel syndrome

The irritable bowel syndrome (IBS) is one of the most common gastrointestinal conditions encountered by general practitioners, and it accounts for a great deal of the workload of gastroenterologists in secondary care. Research to date indicates that several factors contribute to the development of IBS, of which disturbed gastrointestinal motility, altered visceral perception and psychosocial factors are regarded as the three most important mechanisms interacting in the development of this disorder. Most pharmacological research has been based on these insights. Several agents capable of modulating either motility or sensitivity are currently under investigation. Potential drugs in the treatment of diarrhoea-predominant IBS are the more selective antispasmodics, such as the M3-receptor antagonists (e.g. zamifenacin, darifenacin). In constipation-predominant IBS the colokinetic effects of the selective 5HT4 agonists prucalopride and tegaserod are of great interest. Since altered visceral perception is thought to play an important role in the genesis of abdominal pain and bloating in many patients with IBS, new drugs are targeted at modulating the sensitivity, such as 5HT3 antagonists (e.g. alosetron), kappa-agonists (e.g. fedotozine) and somatostatin analogues. Furthermore, psychosocial factors should not be overlooked, since these appear to be of great influence on the clinical outcome of IBS.