Psychopharmacologic Therapies for Irritable Bowel Syndrome

Hans Törnblom; Douglas A Drossman

doi:10.1016/j.gtc.2021.04.005

Psychopharmacologic Therapies for Irritable Bowel Syndrome

Gastroenterol Clin North Am. 2021 Sep;50(3):655-669. doi: 10.1016/j.gtc.2021.04.005. Epub 2021 Jul 1.

Authors

Hans Törnblom¹, Douglas A Drossman²

Affiliations

¹ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-41345, Sweden. Electronic address: hans.tornblom@gu.se.
² Drossman Center for the Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA; The Rome Foundation, Raleigh, NC, USA, and Drossman Gastroenterology, Durham NC, USA.

PMID: 34304793
DOI: 10.1016/j.gtc.2021.04.005

Abstract

Psychopharmacologic therapies are beneficial in reducing symptoms when treating irritable bowel syndrome (IBS) and other disorders of gut-brain interaction (DGBI). Noradrenaline, serotonin, and dopamine are neurotransmitters of key importance in psychopharmacology and pain-reduction mechanisms. The first-line (tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors) and second-line (atypical antipsychotics, delta-ligand agents, low-dose naltrexone) neuromodulator treatment options are recommended when IBS-associated abdominal pain is of moderate or severe intensity and is persistent. To understand the implementation strategy, the multidimensional clinical profile as a template is used for presenting 3 case scenarios involving painful IBS and DGBI of varying complexity.

Keywords: Antidepressants; Disorders of gut brain interaction; Irritable bowel syndrome; Multidimensional clinical profile; Neuromodulator; Treatment.

Publication types

Review

MeSH terms

Abdominal Pain / drug therapy
Abdominal Pain / etiology
Humans
Irritable Bowel Syndrome* / drug therapy