Trinkley Katy E, Nahata Milap C
University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colo., USA.
Digestion. 2014;89(4):253-67. doi: 10.1159/000362405. Epub 2014 Jul 2.
Irritable bowel syndrome (IBS) is a complex syndrome that is difficult to manage. Here we present the evidence supporting medication treatments for specific IBS symptoms, discuss evidence-based management of IBS with medications including dose regimens and adverse effects and review progress on research for new IBS treatments.
Currently, there is evidence to support improvements in specific IBS symptoms following treatment with loperamide, psyllium, bran, lubiprostone, linaclotide, amitriptyline, trimipramine, desipramine, citalopram, fluoxetine, paroxetine, dicyclomine, peppermint oil, rifaximin, ketotifen, pregabalin, gabapentin and octreotide and there are many new medications being investigated for the treatment of IBS. Key Message: Of the medications with demonstrated improvements for IBS symptoms, rifaximin, lubiprostone, linaclotide, fiber supplementation and peppermint oil have the most reliable evidence supporting their use for the treatment of IBS. Onset of efficacy for the various medications has been noted to be as early as 6 days after initiation; however, the efficacy of most medications was not assessed prospectively at predefined periods. Additional studies of currently available and new medications are ongoing and are needed to better define their place in therapy and expand therapeutic options for the treatment of IBS. The most promising new medications for IBS include a variety of novel pharmacologic approaches, most notably the dual μ-opioid receptor agonist and δ-opioid antagonist, JNJ-27018966.
肠易激综合征（IBS）是一种难以管理的复杂综合征。在此，我们展示支持针对特定IBS症状进行药物治疗的证据，讨论IBS药物治疗的循证管理，包括剂量方案和不良反应，并回顾IBS新治疗方法的研究进展。
目前，有证据支持使用洛哌丁胺、车前草、麸皮、鲁比前列酮、利那洛肽、阿米替林、曲米帕明、地昔帕明、西酞普兰、氟西汀、帕罗西汀、双环维林、薄荷油、利福昔明、酮替芬、普瑞巴林、加巴喷丁和奥曲肽治疗后特定IBS症状有所改善，并且有许多新药物正在研究用于治疗IBS。关键信息：在已证明对IBS症状有改善作用的药物中，利福昔明、鲁比前列酮、利那洛肽、补充纤维和薄荷油有最可靠的证据支持其用于治疗IBS。已注意到各种药物的疗效起效最早在开始治疗后6天；然而，大多数药物的疗效未在预定时间段进行前瞻性评估。目前正在对现有药物和新药物进行更多研究，并且需要这些研究来更好地确定它们在治疗中的地位，并扩大IBS的治疗选择。治疗IBS最有前景的新药物包括多种新型药理学方法，最显著的是双重μ-阿片受体激动剂和δ-阿片受体拮抗剂JNJ-27018966。
