Luminary Learning Gastrointestinal Disorder- Issue 1

Pharmacological and Clinical Treatment of Irritable Bowel Syndrome •  25 Conclusions and Future Perspectives Significant improvement of patient’s quality of life, which is an ultimate goal of all anti-IBS thera- pies, can be only achieved if the drug/intervention used satisfies several clearly defined condi- tions. On top of all, a sufficient efficacy and acceptable safety in subjects with IBS is required. Furthermore, selection of a medicine should take into account patients lifestyle, other medicines that are possibly used in the same time and all other contraindications. These issues may particu- larly affect patient’s adherence to medication. To enhance the compliance and satisfaction of the patient, improvement of all symptoms, including diarrhea and/or constipation as well as abdomi- nal pain should be secured by one a single drug. Moreover, reliable estimation of possible drug- related adverse events, such as nausea or headache is critical for proper selection of the drug(s). Noteworthy, the race for novel anti-IBS medications is always on and patients can be reas- sured that several novel, superior compounds will enter the market in the next few years (please see Mosinska et al. [71] and Deiana et al. [72] for detailed information on experimental drugs). As shown in this chapter, a significant number of highly effective and safe synthetic and semi-synthetic drugs is currently available on the market for all types of IBS, often tailored to the needs of particular groups of patients. However, it has to be underlined that there is also a significant group of non-responders who struggle to find an appropriate method of treatment. These people often reach to the complementary and alternative therapies that, as proven clinically, may also provide a long-awaited relief. There are several herbal preparations that may provide at least transient relief, such as peppermint oil capsules (for detailed information please see [73, 74]). Moreover, acupuncture, which is commonly used in China, has emerged as a new potential anti- IBS therapy. However, based on the available data which is often contradictory, it is difficult to state a firm conclusion on its effectiveness and clinical relevance [75–77]. One of the most intrigu- ing forms of therapies is hypnosis, which has been evaluated in large clinical trials (n = 1000) demonstrating its safety and potency in refractory IBS [78]. The mechanism of this method is still unexplained; however, it holds a great promise for many IBS sufferers who do not experience suf- ficient relief with a standard therapy [79]. Acknowledgments The author is supported by the Medical University of Lodz [502-03/1-156-04/502-14-140 to M Salaga] and the National Science Centre [#UMO-2015/16/T/NZ7/00031 and #UMO-2013/11/N/NZ7/02354 to M Salaga]. This study is also sponsored by the Polpharma Scientific Foundation. The author have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Disclosures The authors have nothing to disclose. References 1. Spiller R (2008) Serotonergic agents and the irritable bowel syndrome: what goes wrong? Curr Opin Pharmacol 8:709–714. 2. Mawe GM, Hoffman JM (2013) Serotonin signalling in the gut–functions, dysfunctions and therapeutic targets. Nat Rev Gastroenterol Hepatol 10:473–486. 3. Margolis KG, Stevanovic K, Li Z, Yang QM et al (2014) Pharmacological reduction of mucosal but not neuronal serotonin opposes inflammation in mouse intestine. Gut 63:928–937. 4. Coates MD, Mahoney CR, Linden DR, Sampson JE et al (2004) Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. Gastroenterology 126:1657–1664. 5. Jentsch TJ, Gunther W (1997) Chloride channels: an emerging molecular picture. BioEssays 19:117–126.