Serotonergic Agents in the Treatment of Functional Gastrointestinal Disorders

Functional gastrointestinal disorders are exceptionally common, cause a great deal of suffering, and are extremely challenging to treat. Current therapies, usually targeted at possible abnormalities of gut contractility, are often disappointing and there is a real need for a new approach to treatment. Over the last decade, there has been an increase in our understanding of potential pathophysiologic processes involved in these conditions resulting in novel therapeutic agents based on this information. Serotonin receptor modulators are one such example of this approach, but their development has met with a number of difficulties mainly centered around issues of safety and trial design. It is becoming increasingly apparent that a drug universally effective in all forms of functional gastrointestinal disorders is unlikely to emerge unless some centrally acting compound can achieve this goal. Thus, the current approach of targeting specific subgroups is probably the best strategy. Many patients with functional gastrointestinal disorders do not even bother to consult the medical profession because of the lack of benefit from any currently available treatments. Thus, if a new effective drug is developed, even for a subgroup, demand is likely to be substantial, leading to an even greater burden on already stretched drug budgets.