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Efficacy of antispasmodics on pain relief. The vertical bars represent the difference in the response rates between antispasmodics (Treatment) and placebo. The white circles represent the OR and the horizontal lines the 95%CI. Overall response of each type of antispasmodic is represented by the black diamonds. Antispasmodics were effective on abdominal pain (Overall). Specifically by type of antispasmodics, only Alverine/s and Otilonium were effective.
Source publication
Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit.
To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS.
We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for...
Citations
... The evidences of previous meta-analyses [22][23][24] suggested and proved the efficacy of antispasmodic agents in the treatment of irritable bowel syndrome (IBS). However, antispasmodic agents are available differently in different countries. ...
... However, antispasmodic agents are available differently in different countries. Additionally, the recommendation of effectiveness from Gastroenterology could not concluded because of insufficient information from many countries with inconsistent results in both IBS and colonoscopy patients 22,25,26 . ...
... More recent RCTs, found the efficacy of antispasmodic medication before colonoscopy in terms of lower pain, difficulty, and increased quality of life as same as our results 19,36,37 . In addition, 1 published systematic review and meta-analysis confirmed the benefit of using antispasmodic agents before colonoscopy in decreased irritable bowel syndrome, increased the rate of abdominal pain improvement, improved the rate of relieved abdominal distention/bloating, and without any adverse event 22 . ...
Colonoscopy is the standard procedure for screening, and surveillance of colorectal cancer, including the treatment for colonic lesions. Colonic spasm is an important problem from colonoscopy that affects both surgeons and patients. The spasm also might be the cause of longer cecal intubation time, difficulty of the procedure, and increased pain. Previous reports indicated that antispasmodic agents can decrease such symptoms. Therefore, we conducted this study to investigate the cecal intubation time of antispasmodic agents. A single blinded randomized controlled trial was conducted from 01/11/2020 to 31/08/2021. One hundred four patients were allocated to antispasmodic agent group and control group, in 1:1 ratio. The efficacy of median (range) cecal intubation time showed similar results of 5 (2, 14) and 5 (2, 15) minutes with no statistically significant difference. The mean scores of all domains i.e., pain, spasm, cleanliness, and difficulty were better in the antispasmodic agent group about 2.6 (1.4), 1.8 (0.8), 2.4 (0.9), and 2.0 (0.9), respectively, than control group but there were spasm and cleanliness showed statistically significant difference. Moreover, the satisfaction scores showed better efficacy in decreased spasm, decreased difficulty, and increased cleanliness than control group. Prescribing of antispasmodic drugs before colonoscopy might be the choice of treatment for the patients. The antispasmodic drugs will be beneficial to both of the patient and the doctor.
... In a systematic review and metaanalysis published in 2012, antispasmodics were more effective than placebo, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents (Martínez-Vázquez et al. 2012). Then, the visceral hypersensitivity model of IBS came in 1973 so that drugs aimed to target abdominal pain due to visceral hypersensitivity, and then came the theory of infection/inflammation more recently. ...
The gut and the brain communicate bidirectionally through the autonomic nervous system. The vagus nerve is a key component of this gut–brain axis, and has numerous properties such as anti-inflammatory, antinociceptive, anti-depressive effects. A perturbation of this gut–brain communication is involved in the pathogeny of functional digestive disorders, such as irritable bowel syndrome, and inflammatory bowel diseases. Stress plays a role in the pathogeny of these diseases, which are biopsychosocial models. There are presently unmet needs of pharmacological treatments of these chronic debilitating diseases. Treatments are not devoid of side effects, cost-effective, do not cure the diseases, can lose effects over time, thus explaining the poor satisfaction of patients, their lack of compliance, and their interest for non-drug therapies. The gut–brain axis can be targeted for therapeutic purposes in irritable bowel syndrome and inflammatory bowel disease through non-drug therapies, such as hypnosis and vagus nerve stimulation, opening up possibilities for responding to patient expectations.
... trimebutine, showing a dual mechanism of action, both stimulating and inhibiting peristalsis, works well in patients with constipation and those with a tendency to excessive intestinal spasms, but it also has the highest number of adverse effects and drug interactions. Drotaverine is indicated for alleviation of smooth muscle spasm; however, it has a supportive, not a therapeutic, effect, and unlike the other drugs, it is not recommended for continuous therapy, only occasionally, also as an add-on therapy to the drugs discussed earlier [18,[31][32][33][34][35][36]. ...
Irritable bowel syndrome is a significant health problem that can affect up to 11% of the general population. The problem
is far more common among women and young people, especially in their thirties. The aetiology of the disease is not fully understood,
but it is now thought that dysregulation of the gut-brain axis may be one of the causes. In addition, psychogenic factors, genetics and
dietary habits have been attributed a role in the development of the disease. The diagnosis of the disease is based on the clinical picture
and the exclusion of other organic causes that may lead to clinical symptoms. According to the Rome IV criteria, diagnosis of IBS is
possible when recurrent abdominal pain is found, occurring at least once a week, for the last 3 months. The pain must be accompanied
by at least 2 of the following criteria: it is associated with a bowel movement, with a change in the frequency of bowel movements or
with a change in the consistency of the stool. Irritable bowel syndrome is a chronic, recurrent condition, with varying frequency of exacerbations
and quiescence, dependent on a number of factors. As no clear aetiology has been established to date, we therefore have no
causal treatment and no effective and lasting cure. In this situation, treatment must be comprehensive, involving non-pharmacological
management related to changes in lifestyle and eating habits and, in the absence of adequate therapeutic effects, pharmacological
treatment. Pharmacological treatment should be symptomatic, targeting the predominant complaints and types of IBS, and we can
reach for muscle relaxants, drugs to stimulate intestinal peristalsis, antidepressants, rifaximin, laxatives, antidiarrheals and drugs for
bloating, probiotics and herbal medicines, e.g. peppermint oil.
... Based on these findings, XG + PP may represent a useful etiology-based strategy for the treatment of gastrointestinal disorders by allowing the creation of a protective barrier that prevents the adhesion and proliferation of intestinal bacteria typical of SIBO, promotes the restoration of the integrity and functionality of the mucosal barrier, and helps the regulation of nutrient sensing. In contrast, simethicone acts via a completely different mechanism, decreasing the surface tension of gas bubbles in the gastrointestinal tract and facilitating their elimination, but is not effective in the treatment of SIBO [42]. Although few studies are currently available, they support the role of XG + PP in controlling bloating symptoms by regulating intestinal motility, gut flora, and visceral sensitivity. ...
Background
Functional Abdominal Bloating and Distension (FABD) is a multifaceted condition related in part to trapped gas, with changes in the intestinal barrier and small intestinal bacterial overgrowth (SIBO), which lead to gas production. Currently, there are no treatments targeting the etiology of FABD.
Methods
This double-blind, multicenter, randomized study evaluated the safety and efficacy of a product containing xyloglucan and pea proteins (XG + PP) compared with simethicone, both administered orally (three times daily) for 20 consecutive days. Eighty-eight patients with FABD were randomly assigned to the two groups in a 1:1 ratio. Primary outcome was safety; secondary outcomes were (i) efficacy in alleviating the symptoms of FABD and (ii) efficacy in reducing SIBO, as assessed by hydrogen breath test (HBT).
Results
No Adverse Events or Serious Unexpected Adverse Reactions were reported during the study. XG + PP showed a faster onset of action and a significant reduction in bloating and abdominal pain compared with simethicone. At Day 20, XG + PP drastically reduced abdominal girth when compared with simethicone, with an average reduction of 4.7 cm versus 1.8 cm. At Day 20, the XG + PP arm showed a significant reduction in HBT compared to baseline.
Conclusions
This study supports the evidence that FABD patients may benefit from a XG + PP-based treatment that acts on etiology and not just the symptoms.
... Согласно результатам метаанализа 23 рандомизированных контролируемых исследований (1888 пациентов) спазмолитики оказались эффективнее плацебо при улучшении общего состояния пациента с ОШ 2,13 (95% ДИ 1,77-2,58) [33]. В другом метаанализе показано, что спазмолитики значительно эффективнее плацебо в разрешении абдоминальной боли у пациентов с СРК (ОШ 1,52, 95% ДИ 1,28-1,80) [34]. Пациентам с СРК-Д рекомендуется назначение противодиарейных препаратов различных механизмов действия (лоперамид, Смектит диоктаэдрический, рифаксимин -при ассоциированном СИБР). ...
Irritable bowel syndrome (IBS) is a widespread disease that affects working-age people and significantly reduces their quality of life. Many experts have suggested that the colon microflora in patients with IBS is characterized by dysbiosis, which leads to increased fermentation, excessive gas formation, and symptoms typical of the disease. Currently, alterations of the intestinal microbiota are considered one of the main mechanisms of IBS development, which warrants the use of probiotics with proven effectiveness as a part of the complex therapy. Certain probiotic strains (including Bifidobacterium longum 35624 and Saccharomyces boulardii CNCM I-745) have been shown to be effective in normalizing stool frequency and consistency in IBS patients, regressing abdominal pain, and normalizing quality of life.
... Назначение тримебутина рекомендовано целым рядом согласительных документов: Российской гастроэнтерологической ассоциацией (РГА), Союзом педиатров России и Российским обществом детских гастроэнтерологов, гепатологов и нутрициологов [5,[35][36][37]. Доказана эффективность препарата при лечении синдрома раздраженного кишечника [38][39][40][41], функциональной диспепсии [42,43], функциональных запоров [44,45], билиарных дисфункций [29,46] и сочетанных функциональных заболеваний (т. н. «синдрома перекреста») [30,47,48]. ...
The article explores modern concepts about functional gastrointestinal disorders in children, considers features of the classification according to the Rome criteria and Russian clinical guidelines, and presents the evolution of views in the context of understanding the general pathophysiological mechanism as impaired “gut-brain” interactions, which leads to dysmotility in different parts of the gastrointestinal tract, visceral hypersensitivity, changes in the local immune system functions, dysbiosis of the gut microbiota and a failure of the central nervous system to process signals. Dysregulation of the central nervous system and the enteric nervous system causes functional gastrointestinal disorders with pain syndrome: irritable bowel syndrome, functional dyspepsia and centrally mediated abdominal pain syndrome. In addition, the article discusses the Russian version of the guidelines due to differences in the diagnostic instrumental and laboratory facilities, as well as national peculiarities of marketing authorization, indications and contraindications for drug use in children. Subject to understanding of the mechanisms of functional gastrointestinal disorders in children, the authors presented information on the role of trimebutine, a universal motility regulator of different parts of the gastrointestinal tract, in the development of functional gastrointestinal disorders, as well as modern approaches to their prevention and correction using a drug of proven efficacy. Numerous national and foreign studies proved the efficacy of trimebutine in hyperkinetic and hypokinetic movement disorders, decreased gastric evacuation function, and impaired gallbladder contractile function in patients with both hypomotor and hypermotor types of functional disorders. The accumulated experience determines the prospects for its use in pediatric practice.
... 79 Dos revisiones sistemáticas encontraron que el tratamiento con trimebutina es más efectivo que el placebo en la mejora del dolor abdominal en pacientes con SII, aunque los resultados estadísticamente significativos difieren entre ambos estudios. 78,80 Los antiespasmódicos anticolinérgicos como el butilbromuro de hioscina, la hiosciamina, la dicicloverina, el propinoxato y el bromuro de cimetropio reducen los espasmos intestinales y por lo tanto el dolor abdominal. Sin embargo, pueden tener efectos secundarios como cefalea, mareo y xerostomía. ...
... El estreñimiento y la confusión son otros efectos adversos reportados. [80][81] El propinoxato es un antiespasmódico con un mecanismo de acción dual: musculotropo y anticolinérgico. Actúa directamente en las células del músculo liso visceral para reducir los espasmos y presenta un bloqueo moderado y no selectivo de las fibras colinérgicas muscarínicas. ...
El síndrome de intestino irritable sigue siendo uno de los trastornos gastrointestinales más comunes observados por los médicos, tanto en la atención primaria como en la secundaria. Se han logrado avances significativos en la comprensión de su compleja fisiopatología, lo que resulta en su reclasificación como un trastorno de la interacción intestino-cerebro, en lugar de un trastorno gastrointestinal funcional. La condición afecta a entre el 5% y el 10% de la población y, en la mayoría de los casos, se caracteriza por tener una evolución con recaídas y remisiones. El diagnóstico se puede hacer sobre la base de la historia clínica con un uso limitado y juicioso de las investigaciones, a menos que se presenten síntomas de alarma, como pérdida de peso o sangrado rectal, o que haya antecedentes familiares de enfermedad inflamatoria intestinal o enfermedad celíaca. Los pilares del tratamiento incluyen la educación del paciente sobre la afección, los cambios en la dieta, la fibra soluble y los medicamentos antiespasmódicos. Otros tratamientos tienden a estar reservados para personas con síntomas refractarios e incluyen neuromoduladores centrales, secretagogos intestinales, medicamentos que actúan sobre los receptores opioides o 5-hidroxitriptamina o serotonina (5-HT), o antibióticos mínimamente absorbidos (todos los cuales se seleccionan de acuerdo con el hábito intestinal predominante), así como terapias psicológicas. Este consenso es el resultado del trabajo en conjunto de representantes de la Asociación Centroamericana y del Caribe de Gastroenterología, desarrollado de forma virtual, con el objetivo de presentar una serie de recomendaciones adaptadas a la realidad de la región y que sirvan de referencia en la práctica clínica.
... Тримебутин -спазмолитик, оказываю щий влияние на периферические σ-, µ-и κ-опиоидные рецепторы, в том числе находящиеся непосредственно на гладкой мускулатуре на всем протяжении ЖКТ, а также оказывающий регулирующее действие на моторику ЖКТ без влияния на центральную нервную систему [26]. Тримебутин также подтвердил свою эффективность в лечении пациентов с СРК без развития каких-либо значительных побочных эффектов [27]. ...
Irritable bowel syndrome (IBS) is a common functional disease of the gastrointestinal tract, affecting a large number of adults worldwide, and leads to a significant decrease in the quality of life. IBS places a heavy burden on patients, most of whom are able-bodied population, as well as doctors and the healthcare system. The pathogenesis of this disease is multifactorial and includes the brain-intestine axis, disorders of the immune function of the mucous membrane, visceral hypersensitivity, changes in the motility of the gastrointestinal tract, changes in the microbial composition of the intestine. Based on the fact that changes in intestinal motility and visceral hypersensitivity are among the key factors in the pathogenesis of the disease, he use of antispasmodic drugs as part of complex therapy is justified. Mebeverin is a myotropic antispasmodic drug recommended for use in patients with IBS according to Rome IV Criteria, as well as clinical recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia. According to available data, mebeverin has proven to be an effective and safe antispasmodic used to treat patients with IBS. The article presents a clinical case demonstrating the experience of effective use of the drug Mebespalin®. A patient with a diagnosis of IBS with a predominance of constipation is recommended to take an antispasmodic, as well as lifestyle modification – the addition of fiber-rich foods, sufficient drinking regime and increased physical activity. A week after the start of treatment, the patient noted an improvement in her condition – abdominal pain did not bother, the stool normalized.
... compared to placebo, but in fact there is no evidence for specific relief of pain based on relatively low quality of evidence from few randomized controlled trials. Typical adverse effects are dry mouth, dizziness, and blurry vision, though the risk is small with the number needed to harm (NNH) of 17.5 (Ford et al., 2008;Martinez-Vazquez et al., 2012). ...
The objectives of this narrative review are to update readers on the current state-of-the-art regarding diverse approaches for the treatment of pain, global symptoms, or adequate relief in irritable bowel syndrome (IBS). The article appraises medications, dietary interventions including low fermentable oligosaccharides, disaccharides, and monosaccharides and polyols (FODMAP) diet, fecal microbial transplantation (FMT), electrical approaches, and behavioral therapies including cognitive behavioral therapy (CBT), gut-directed hypnotherapy (GDH), mindfulness, and open-label placebo. Current evidence demonstrates only modest benefit in global IBS symptoms and pain relief. A future approach that identifies pathophysiological mechanisms of IBS through validated biomarkers has the potential to individualize treatment of patients rather than sequential therapeutic trial and error approaches.
... In a comprehensive systematic review and metaanalysis conducted by Martínez-Vázquez et al. in 2012, the clinical effectiveness of antispasmodics available in Mexico was thoroughly evaluated (30). The authors made an interesting observation that the addition of simethicone not only enhanced the properties of alverine but also exhibited a similar effect with pinaverium. ...
