과민성장증후군 치료전략: 언제, 어떤 약을 사용할 것인가?
Strategy to Manage Irritable Bowel Syndrome in Korea
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초록
Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multi-factorial disorderdue to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, and communication between thegut-brain axis. IBS is traditionally treated with dietary and lifestyle modifications, fiber supplementation, and psychological andpharmacological therapies. Diet therapy including the low FODMAP diet and excluding certain food constituents is often used. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are first-line drug treatments. 5-Hydroxytryptamine (5-HT) receptors in the gastrointestinal tract, particularly 5-HT3 and 5-HT4 receptors are involved not only inmodulating gut motility but in visceral sensory pathways. Drugs that act on both receptor classes appear to reduce visceralsensitivity and have inhibitory effects on motor activity in the distal intestine. 5-HT4 agonists may improve constipationpredominantIBS by normalizing bowel habits and thereby reduce abdominal pain. IBS continues to be a therapeutic challengebecause of its diverse symptomatology and lack of a single pathophysiological target for drug intervention.
Abstract
Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multi-factorial disorderdue to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, and communication between thegut-brain axis. IBS is traditionally treated with dietary and lifestyle modifications, fiber supplementation, and psychological andpharmacological therapies. Diet therapy including the low FODMAP diet and excluding certain food constituents is often used. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are first-line drug treatments. 5-Hydroxytryptamine (5-HT) receptors in the gastrointestinal tract, particularly 5-HT3 and 5-HT4 receptors are involved not only inmodulating gut motility but in visceral sensory pathways. Drugs that act on both receptor classes appear to reduce visceralsensitivity and have inhibitory effects on motor activity in the distal intestine. 5-HT4 agonists may improve constipationpredominantIBS by normalizing bowel habits and thereby reduce abdominal pain. IBS continues to be a therapeutic challengebecause of its diverse symptomatology and lack of a single pathophysiological target for drug intervention.
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