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.