Central Neuromodulators in Irritable Bowel Syndrome: Why, How, and When.
Ignacio Hanna-JairalaDouglas A DrossmanPublished in: The American journal of gastroenterology (2024)
Irritable bowel syndrome (IBS) is responsive to treatments using central neuromodulators. Central neuromodulators work by enhancing the synaptic transmission of 5-hydroxytryptamine, noradrenalin, and dopamine, achieving a slower regulation or desensitization of their postsynaptic receptors. Central neuromodulators act on receptors along the brain-gut axis, so they are useful in treating psychiatric comorbidities, modifying gut motility, improving central downregulation of visceral signals, and enhancing neurogenesis in patients with IBS. Choosing a central neuromodulator for treating IBS should be according to the pharmacological properties and predominant symptoms. The first-line treatment for pain management in IBS is using tricyclic antidepressants. An alternative for pain management is the serotonin and noradrenaline reuptake inhibitors. Selective serotonin reuptake inhibitors are useful when symptoms of anxiety and hypervigilance are dominant but are not helpful for treating abdominal pain. The predominant bowel habit is helpful when choosing a neuromodulator to treat IBS; selective serotonin reuptake inhibitors help constipation, not pain, but may cause diarrhea; tricyclic antidepressants help diarrhea but may cause constipation. A clinical response may occur in 6-8 weeks, but long-term treatment (usually 6-12 months) is required after the initial response to prevent relapse. Augmentation therapy may be beneficial when the therapeutic effect of the first agent is incomplete or associated with side effects. It is recommended to reduce the dose of the first agent and add a second complementary treatment. This may include an atypical antipsychotic or brain-gut behavioral treatment. When tapering central neuromodulators, the dose should be reduced slowly over 4 weeks but may take longer when discontinuation effects occur.
Keyphrases
- irritable bowel syndrome
- pain management
- chronic pain
- mental health
- white matter
- stem cells
- type diabetes
- escherichia coli
- skeletal muscle
- spinal cord injury
- spinal cord
- pseudomonas aeruginosa
- signaling pathway
- mesenchymal stem cells
- bone marrow
- metabolic syndrome
- neuropathic pain
- multiple sclerosis
- bipolar disorder
- preterm birth
- gestational age
- cerebral ischemia
- uric acid
- free survival