Gastrointestinal Pharmacology.
Abstract: There is little evidence for most of the medications currently used to treat functional abdominal pain disorders (FAPDs) in children. Not only are there very few clinical trials, but also most have significant variability in the methods used and outcomes measured. Thus, the decision on the most appropriate pharmacological treatment is frequently based on adult studies or empirical data. In children, peppermint oil, trimebutine, and drotaverine have shown significant benefit compared with placebo, each of them in a single randomized clinical trial. A small study found that cyproheptadine was beneficial in the treatment of FAPDs in children. There are conflicting data regarding amitriptyline. While one small study found a significant benefit in quality of life compared with placebo, a large multicenter study found no benefit compared with placebo. The antidepressant, citalopram, failed to meet the primary outcomes in intention-to-treat and per-protocol analysis. Rifaximin has been shown to be efficacious in the treatment of adults with IBS. Those findings differ from studies in children where no benefit was found compared to placebo. To date, there are no placebo-controlled trials published on the use of linaclotide or lubiprostone in children. Alpha 2 delta ligands such as gabapentin and pregabalin are sometimes used in the care of this group of children, but no clinical trials are available in children with FAPDs. Similarly, novel drugs that have been approved for the care of irritable bowel with diarrhea in adults such as eluxadoline have yet to be studied in children. Little data support the use of most medications commonly used to treat FAPDs in children. More randomized, placebo-controlled studies are needed to assess the efficacy of pharmacological interventions in the treatment of FAPDs in children.
Publication Date: 2017-02-27 PubMed ID: 28236087DOI: 10.1007/164_2016_119Google Scholar: Lookup
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Summary
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The research article is about the pharmacological treatment of different diseases that affect the gastrointestinal tract, discussing the benefits and drawbacks of using certain drugs.
Gastrointestinal Diseases and Pharmaceutical Treatment
- The research starts by detailing different diseases that impact the gastrointestinal tract; these include gastric ulcers, colic, diarrhea, reperfusion injury, postoperative ileus, and adhesions. Each disease generally requires a combination of pharmacologic management and other treatment methods.
- For example, gastric ulcers are commonly treated with medications such as omeprazole. Colic can be managed with laxatives and analgesics while diarrhea can be treated with antibiotics, protectants and absorbents, glucocorticoids, and motility inhibitors. Postoperative ileus may require prokinetic drugs.
Effects of Nonsteroidal Anti-Inflammatory Drugs
- The paper provides evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) can modify important physiological properties of the intestine. Despite this, such drugs are important pain relievers for horses.
- However, the author warns about the danger that these drugs may carry, noting that their use should be balanced with an awareness of their potential harmful effects.
Role of Antibiotics in Treating Gastrointestinal Diseases
- Finally, the study discusses the use of antibiotics in the treatment of gastrointestinal diseases. While this practice can be controversial, antibiotics can unfortunately cause life-threatening diarrhea in some cases. This serious side effect calls for careful and justified use of these drugs, particularly in horses.
Cite This Article
APA
Saps M, Miranda A.
(2017).
Gastrointestinal Pharmacology.
Handb Exp Pharmacol, 239, 147-176.
https://doi.org/10.1007/164_2016_119 Publication
Researcher Affiliations
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA. miguel.saps@nationwidechildrens.org.
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
MeSH Terms
- Adolescent
- Age of Onset
- Animals
- Child
- Gastrointestinal Agents / therapeutic use
- Gastrointestinal Diseases / drug therapy
- Gastrointestinal Diseases / epidemiology
- Gastrointestinal Diseases / physiopathology
- Gastrointestinal Tract / drug effects
- Gastrointestinal Tract / physiopathology
- Humans
- Treatment Outcome
Citations
This article has been cited 10 times.- Lambiase C, Rettura F, Sciumè GD, Tedeschi R, Grosso A, Cancelli L, Bottari A, Fornai M, Antonioli L, de Bortoli N, Bellini M. Targeting γ-aminobutyric acid pathways in irritable bowel syndrome: bridging central nervous system, enteric dysfunction, and the microbiota-gut-brain axis. Front Pharmacol 2025;16:1677037.
- Di Nardo G, Barbara G, Borrelli O, Cremon C, Giorgio V, Greco L, La Pietra M, Marasco G, Pensabene L, Piccirillo M, Romano C, Salvatore S, Saviano M, Stanghellini V, Strisciuglio C, Tambucci R, Turco R, Zenzeri L, Staiano A. Italian guidelines for the management of irritable bowel syndrome in children and adolescents : Joint Consensus from the Italian Societies of: Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP), Pediatrics (SIP), Gastroenterology and Endoscopy (SIGE) and Neurogastroenterology and Motility (SINGEM). Ital J Pediatr 2024 Mar 14;50(1):51.
- Salvatore S, Carlino M, Sestito S, Concolino D, Agosti M, Pensabene L. Nutraceuticals and Pain Disorders of the Gut-Brain Interaction in Infants and Children: A Narrative Review and Practical Insights. Nutrients 2024 Jan 25;16(3).
- Santucci NR, Sahay R, El-Chammas KI, Graham K, Wheatley M, Vandenbrink M, Hardy J, Fei L. Percutaneous electrical nerve field stimulation compared to standard medical therapy in adolescents with functional abdominal pain disorders. Front Pain Res (Lausanne) 2023;4:1251932.
- Rexwinkel R, Vlieger AM, Saps M, Tabbers MM, Benninga MA. A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. Eur J Pediatr 2022 Jul;181(7):2603-2617.
- Cordeiro Santos ML, da Silva Júnior RT, de Brito BB, França da Silva FA, Santos Marques H, Lima de Souza Gonçalves V, Costa Dos Santos T, Ladeia Cirne C, Silva NOE, Oliveira MV, de Melo FF. Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives. World J Clin Pediatr 2022 Mar 9;11(2):105-119.
- Gordon M, Sinopoulou V, Tabbers M, Rexwinkel R, de Bruijn C, Dovey T, Gasparetto M, Vanker H, Benninga M. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022 Jun 1;176(6):560-568.
- Erwin SJ, Blikslager AT, Ziegler AL. Age-Dependent Intestinal Repair: Implications for Foals with Severe Colic. Animals (Basel) 2021 Nov 23;11(12).
- Pensabene L, Salvatore S, D'Auria E, Parisi F, Concolino D, Borrelli O, Thapar N, Staiano A, Vandenplas Y, Saps M. Cow's Milk Protein Allergy in Infancy: A Risk Factor for Functional Gastrointestinal Disorders in Children?. Nutrients 2018 Nov 9;10(11).
- Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol 2018 Jun 7;24(21):2211-2235.
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