Professor Michael Camilleri and Dr Boeckxstaens from Minnesota, USA introduced the principles of visceral sensation, and appraised the current approaches to management of visceral pain in functional GI diseases, principally IBS.
These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet.
The team report that pharmacological approaches include antispasmodics, peppermint oil, antidepressants, 5-HT3 receptor antagonists, non-absorbed antibiotic, secretagogues, μ-opioid receptor, and κ-opioid receptor agonist, eluxadoline, histamine H1 receptor antagonist, neurokinin-2 receptor antagonist, and GABAergic agents.
|Potential new approaches may be based on recent insights on mucosal expression of genes|
The researchers discuss efficacy and safety based on pivotal trials or published systematic reviews and meta-analysis, expressing opioid receptors or relative risks and their 95% CIs.
Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.
Professor Camilleri and colleague conclude, "The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain of several classes of therapies."
"These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols, and different classes of medications."