Pharmacological Ad-vancements in the Management of Constipation-Predominant Irritable Bowel Syndrome: A Comprehensive Review | Chapter 6 | Medical Science: Trends and Innovations Vol. 4

Irritable bowel syndrome (IBS) is a complex disorder of gut-brain interaction (DGBI). It affects a diverse population across various age groups and ethnicities. IBS is a common medical disorder worldwide, with reported prevalence rates ranging from 5% to 35%. Patients diagnosed with IBS often experience significant disruptions in their daily activities and a diminished quality of life, which can be attributed to the limited effectiveness of conventional treatment options. Additionally, the long-term consequences of the condition may give rise to psychological challenges, potentially resulting in polypharmacy or the concurrent use of multiple medications. This scenario presents inherent risks, including the possibility of drug interactions, a decline in overall health, and increased healthcare costs. The symptoms of IBS may include abdominal pain and bloating, frequently associated with visceral hypersensitivity and psychological factors, along with diarrhea, constipation, or a combination of these bowel patterns. In accordance with the Rome IV criteria, IBS is classified based on different types of bowel patterns. There are four recognized subtypes of IBS: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed IBS (IBS-M), and unsubtyped IBS (IBS-U). This classification system facilitates the accurate diagnosis and effective management of the condition.

The IBS-C subtype affects a significant number of patients, particularly older adults and those from lower socioeconomic backgrounds. Recent studies indicate that IBS-C is linked to higher levels of functional impairment compared to other subtypes of IBS.

Conventional pharmacological and non-pharmacological treatment options for IBS-C have limited effectiveness and may cause significant adverse effects. This results in higher long-term healthcare costs. Over the past few decades, the ineffectiveness in treating patients with IBS-C has largely stemmed from a poor understanding of the disease's pathophysiology, a failure to consider the patient as a whole, and inappropriate patient selection and treatment endpoints in clinical trials.

Over the past two decades, significant advancements have been made in the development of effective and safer pharmacologic treatments for IBS-C. These advancements are grounded in an enhanced understanding of the pathophysiological mechanisms underlying IBS-C and the introduction of medications that demonstrate increased selectivity within established pharmacologic classes recognized for their efficacy.

This narrative review aims to provide a comprehensive overview of the available treatment options for IBS-C, highlighting their mechanisms of action, as well as their efficacy and safety profiles as determined by pertinent clinical trials. The review commences with a summary of laxative-based therapies and subsequently offers an up-to-date evaluation of four distinct classes of medications: prokinetics, prosecretory agents, bile acid modulators, and tenapanor.

 

Author (s) Details

Khaled Jadallah
Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

 

Roberto De Giorgio
Department of Translational Sciences, University of Ferrara, Ferrara, Italy.

 

Rami Jadallah
Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v4/4177

Management of Henoch-Schonlein Purpura Treated with Oral Steroids | Chapter 7 | Current Practice in Medical Science Vol. 1

A 38-year-old man with irritable bowel syndrome (IBS) visited the clinic complaining of acute rash and severe central abdominal discomfort. The day before visiting the clinic, the patient visited the Emergency Department (ED) with the same problems. The patient described the pain in his or her stomach as colicky. He had an upper respiratory tract infection three weeks before, during which he started to have these symptoms. However, there were no further symptoms, such as nausea, vomiting, or GI bleeding. He received medical attention for his condition, which immediately got better. The ED staff investigated the reason and ran a contrast-enhanced CT abdomen, but all of the results were negative. His serum creatinine level was somewhat high at the time. The patient's abdomen was quite painful during a clinical examination. He had a large, crimson, raised rash that was purpuric in colour that covered both of his hips and lower limbs. Up to the forearms, the upper limbs were also engaged.

All of the patient's lab tests, including the CBC, creatinine, serum C3, C4, and rheumatoid factor, were normal. Positive occult blood was discovered in the patient's stool, and CRP was discovered to be high.

Using a combination of the aforementioned medical symptoms and tests, the patient's condition was determined to be abdominal angina. The symptoms were consistent with the usual pattern: purpuric rash, stomach discomfort, involvement of the kidneys, occult blood in the stool, all of which were preceded by a confirmed upper respiratory tract infection (URTI). The patient was eventually diagnosed with immune-mediated IgA vasculitis (also known as Henoch-Schonlein purpura) and received treatment as a result.

In the parts that follow, we'll look at how the patient was identified, treated, and managed appropriately to preserve his life. As a result, this case will serve as crucial study material for all interested physicians and doctors, enabling them to prepare for the possibility that they could face a patient like this in a clinical context. The example explains how uncertainties should be handled when facing such perplexing instances by thoroughly examining all the factors that contributed to the patient's final diagnosis.

Author(s) Details:

Mohamed Eltaieb Ali,

Department of Internal Medicine, Madinat Zayed Hospital, UAE.

Ashraf Alakkad,

Department of Internal Medicine, Madinat Zayed Hospital, UAE.

Please see the link here: https://stm.bookpi.org/CPMS-V1/article/view/7326