Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.
Abdominal Pain ; Anti-Bacterial Agents ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bile ; Chloride Channel Agonists ; Constipation ; Diarrhea ; Dietary Fiber ; Drug Therapy* ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome* ; Laxatives ; Muscle, Smooth ; Parasympatholytics ; Probiotics ; Quality of Life ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin 5-HT4 Receptor Agonists ; Serotonin Uptake Inhibitors

Irritable bowel syndrome is a group of symptoms that includes abdominal pain and changes in the form and frequency of stool. Since its symptoms are usually long-lasting, the disease significantly degrades quality of life. Several pharmacological therapies have been suggested according to the type of symptoms (e.g., abdominal pain, constipation, or diarrhea). In order to control abdominal pain, smooth muscle antispasmodics, antidepressants including tricyclic antidepressants and selective serotonin reuptake inhibitors, or 5-HT3 antagonists can be used. To improve constipation, dietary fiber or laxatives, 5-HT4 agonists, and chloride channel activators are available. Opioid agonists, mixed opioid agonists/antagonists such as eluxadoline, and bile salt sequestrants can be considered for diarrhea. In addition, probiotics and non-absorbable oral antibiotics can be used for the normalization of the gut microbiome and the treatment of small intestinal bacterial overgrowth, respectively. It is necessary to understand the characteristics of each drug and their combinations, because any single regimen cannot improve all symptoms in patients with irritable bowel syndrome. In this review, the mechanisms of action, efficacy, and adverse events associated with drugs used for irritable bowel syndrome are summarized.
Abdominal Pain ; Anti-Bacterial Agents ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bile ; Chloride Channel Agonists ; Constipation ; Diarrhea ; Dietary Fiber ; Drug Therapy* ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome* ; Laxatives ; Muscle, Smooth ; Parasympatholytics ; Probiotics ; Quality of Life ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin 5-HT4 Receptor Agonists ; Serotonin Uptake Inhibitors

OBJECTIVE: There is no research regarding the appropriate antiemetic agents for female patients, especially those receiving moderately emetogenic chemotherapy (MEC). We evaluated the antiemetic efficacy of a combination of 5-HT3 receptor with/without aprepitant in patients with gynecological cancer treated with the TC (paclitaxel and carboplatin) regimen of MEC. METHODS: We enrolled 38 patients diagnosed with gynecologic cancer and scheduled to receive the TC regimen. The patients were randomly assigned to receive a 5-HT3 receptor antagonist, either palonosetron in the first cycle followed by granisetron in the second cycle or vice versa. In the third cycle, all patients received a combination of the 5-HT3 receptor and dexamethasone with/without aprepitant. RESULTS: When three drugs were administered, palonosetron consistently produced an equivalent complete response (CR) rate to granisetron in the acute phase (89.5% vs. 86.8%, p=0.87) and delayed phase (60.5% vs. 65.8%, p=0.79). With regard to the change in dietary intake, palonosetron exhibited similar efficacy to granisetron in the acute phase (92.1% vs. 89.4%, p=0.19) and delayed phase (65.7% vs. 68.4%, p=0.14). However, in the delayed phase, the addition of aprepitant therapy with a 5-HT3 receptor antagonist and dexamethasone produced a higher CR rate than a 5-HT3 receptor antagonist with dexamethasone (93.3% vs. 47.8%, p<0.001) and allowed the patients to maintain a higher level of dietary intake (93.3% vs. 56.5%, p<0.001). CONCLUSION: The addition of aprepitant therapy was more effective than the control therapy of a 5-HT3 receptor antagonist, and dexamethasone in gynecological cancer patients treated with the TC regimen.
Adult ; Aged ; Antiemetics/*administration & dosage ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Carboplatin/administration & dosage/adverse effects ; Cross-Over Studies ; Diet ; Drug Administration Schedule ; Female ; Genital Neoplasms, Female/*drug therapy ; Granisetron/administration & dosage ; Humans ; Isoquinolines/administration & dosage ; Middle Aged ; Morpholines/administration & dosage ; Nausea/chemically induced/*prevention & control ; Paclitaxel/administration & dosage/adverse effects ; Quinuclidines/administration & dosage ; Serotonin 5-HT3 Receptor Antagonists ; Vomiting/chemically induced/*prevention & control

Serotonin syndrome is an unexpected adverse reaction of serotonergic medication. Some drugs used by anesthesiologists may cause serotonin syndrome. Serotonin syndrome is known to be related to 5-hydroxytryptamine 1A and 5-hydroxytryptamine 2A agonism. However, recent research has revealed evidence that 5-hydroxytryptamine 3 (5-HT3) antagonism can also play a role in serotonin syndrome. Among the 5-HT3 antagonists, palonosetron is the most highly specific. In this study, we present the first case of fentanyl- and meperidine-induced serotonin syndrome precipitated by palonosetron in general anesthesia.
Anesthesia, General ; Felodipine ; Fentanyl* ; Meperidine* ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin Syndrome* ; Serotonin*

No abstract available.
Antidiarrheals/*therapeutic use ; Benzimidazoles/*therapeutic use ; Diabetes Mellitus, Type 2/*complications ; Diarrhea/diagnosis/*drug therapy/etiology/physiopathology ; Endoscopy, Gastrointestinal ; Gastrointestinal Transit/*drug effects ; Humans ; Male ; Middle Aged ; Serotonin 5-HT3 Receptor Antagonists/*therapeutic use ; Treatment Outcome

Functional nausea and vomiting is a broad term used to be described a subset of individuals who have chronic nausea and vomiting without apparent cause, despite extensive evaluation. According to the Rome III criteria, functional nausea and vomiting can be subdivided into three separate entities: chronic idiopathic nausea, functional vomiting and cyclic vomiting syndrome. Although no specific test can diagnose these diseases, the diagnostic approach requires excellent history taking combined with judicious diagnostic testing to exclude some organic cause of chronic nausea and vomiting. These conditions are probably not psychogenic in origin. Treatment remains empirical for all patients with functional nausea and vomiting. Reassurance and supportive physician-patient relationship, along with use of low-dose tricyclic antidepressants, can be beneficial in caring for patients with chronic idiopathic nausea and functional vomiting. The cornerstones of management for patients with cyclic vomiting syndrome are identifying and avoidance of triggering factors, treatment with prophylactic antimigraine agents, 5-HT3 antagonists, benzodiazepines and 5-HT1 agonists (sumatriptan), with supportive therapy.
Antidepressive Agents, Tricyclic ; Benzodiazepines ; Diagnostic Tests, Routine ; Humans ; Nausea ; Rome ; Serotonin 5-HT1 Receptor Agonists ; Serotonin 5-HT3 Receptor Antagonists ; Vomiting

Chemotherapy induced nausea and vomiting (CINV) is typically biphasic. The acute phase usually peaks in 5-6 hours after the administration of chemotherapeutic agents and the delayed phase can occur subsequently over 24hours after chemotherapy. Antiemetic therapy is crucial to prevent this unwanted side effect effectively, and NK1 antagonist, 5-HT3 antagonist, corticosteroid are the main player. The combination and dosing is determined by the emetogenicity of the chemotherapeutic agents to be administrated.
Antiemetics ; Nausea ; Serotonin 5-HT3 Receptor Antagonists ; Vomiting

BACKGROUND: 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone. METHODS: Among the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups. RESULTS: The frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups. CONCLUSIONS: There were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.
Anesthesia, General ; Dexamethasone ; Female ; Gynecologic Surgical Procedures ; Humans ; Incidence ; Isoquinolines ; Postoperative Nausea and Vomiting ; Quinuclidines ; Risk Factors ; Serotonin ; Serotonin 5-HT3 Receptor Antagonists ; Thyroidectomy ; Tympanoplasty

Migrating motor complex (MMC) is well characterized by the appearance of gastrointestinal contractions in the interdigestive state. This review article discussed the mechanism of gastrointestinal MMC. Luminal administration of 5-hydroxytryptamine (5-HT) initiates duodenal phase II followed by gastrointestinal phase III with a concomitant increase of plasma motilin release in conscious dogs. Duodenal 5-HT concentration is increased during gastric phase II and phase III. Intravenous infusion of motilin increases luminal 5-HT content and induces gastrointestinal phase III. 5-HT4 antagonists significantly inhibits both of gastric and intestinal phase III, while 5-HT3 antagonists inhibited only gastric phase III. These suggest that gastrointestinal MMC cycle is mediated via the interaction between motilin and 5-HT by the positive feedback mechanism. Gastric MMC is regulated via vagus, 5-HT3/4 receptors and motilin, while intestinal MMC is regulated via intrinsic primary afferent neurons and 5-HT4 receptors. Stress is highly associated with the pathogenesis of functional dyspepsia. Acoustic stress attenuates gastric phase III without affecting intestinal phase III in conscious dogs, via reduced vagal activity and increased sympathetic activity. It has been shown that subset of functional dyspepsia patients show reduced vagal activity and impaired gastric phase III. The physiological importance of gastric MMC is a mechanical and chemical cleansing of the empty stomach in preparation for the next meal. The impaired gastric MMC may aggravate dyspeptic symptoms following a food ingestion. Thus, maintaining gastric MMC in the interdigestive state is an important factor to prevent the postprandial dyspeptic symptoms.
Acoustics ; Animals ; Autonomic Pathways ; Contracts ; Dogs ; Dyspepsia ; Eating ; Enterochromaffin Cells ; Humans ; Infusions, Intravenous ; Meals ; Motilin ; Myoelectric Complex, Migrating ; Neurons, Afferent ; Phenobarbital ; Plasma ; Receptors, Serotonin, 5-HT4 ; Serotonin ; Serotonin 5-HT3 Receptor Antagonists ; Serotonin 5-HT4 Receptor Antagonists ; Stomach

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Dyspepsia/diet therapy/*therapy ; Gastroscopy ; Helicobacter Infections/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Proton Pump Inhibitors/therapeutic use ; Psychotherapy ; Serotonin 5-HT3 Receptor Antagonists/therapeutic use ; Vasoconstrictor Agents/therapeutic use