Abdominal pain syndrome in patients with irritable bowel syndrome: features of selection of therapy

Abstract

Irritable  bowel  syndrome  (IBS) is an important social problem, since  it is often  diagnosed in people  of young working age, significantly affects  the quality of life of patients and causes  economic  damage  to society. IBS is a chronic functional  bowel disease,  the  main  manifestation of which  is pain  combined  with  changes  in bowel  movements, frequency  and  character of stool. The mechanism  of formation of abdominal  pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads  to changes  in the  regulation of intestinal motor  function  and the  development of visceral  hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs  for pain  relief  are  antispasmodics, which reduce  the  tone  and  contractility  of intestinal smooth  muscles, effectively coping  with  abdominal  pain. The domestic  pharmaceutical market  is represented by different  groups  of muscle  relaxants, among  which  calcium  channel  blockers  are  of particular  relevance for patients with  IBS. Representative  of the  latter  is the drug Otilonium bromide, which is widely used throughout the world, is effective  and safe, well tolerated and superior  to placebo  in reducing symptoms  and preventing relapse  of pain in patients with IBS. The effectiveness of otilonium  bromide is due to a triple  mechanism  of action: blockade  of calcium channels (relief of spasm), antagonism of tachykinone  NK2 receptors  (effect  on HHV) and  inhibition  of acetylcholine muscarinic  receptors (M3-ChR) (reduction  of intestinal secretion). This article  presents a short  review  of the  literature on the  causes  and  mechanism  of development of pain  in IBS, as well  as the possibilities  of its relief, primarily with the use of smooth  muscle relaxants, namely otilonium  bromide.