Spasmolytics for irritable bowel syndrome


Spasmolytic therapy of irritable bowel syndrome, based on the principle of evidence-based medicine

Maev I.V. Cheremushkin S.V. Kucheryavyy Yu.A. Cheremushkina N.V.

The Roman diagnostic criteria for irritable bowel syndrome (IBS) III are considered. The principles of classification of IBS are discussed, the data on its epidemiology and pathophysiological aspects are presented. From the standpoint of evidence-based medicine, modern approaches to the treatment of IBS are considered. It is emphasized that antispasmodics have been and remain the basis of treatment of IBS. Their appointment is expedient from the standpoint of not only arresting spastic reactions of the intestine, but also affecting visceral Hypersensitivity as one of the main pathogenetic links of the syndrome by reducing sensitivity nociceptors.

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About the authors / For correspondence

Maev Igor Veniaminovich - Corresponding member. RAMS, doctor of medical sciences, professor, head of the department of propaedeutics of internal diseases and gastroenterology of the medical faculty of MGMSU.
Cheremushkin Sergey Viktorovich - Candidate of Medical Sciences, Assistant of the Department of Propaedeutics of Internal Medicine and Gastroenterology of the Medical Faculty of MGMSU.
e-mail: [email protected];
Kucheryavy Yuri Alexandrovich - Candidate of Medical Sciences, Associate Professor of the Department of Propaedeutics of Internal Medicine and Gastroenterology, GOU VPO MGMSU.
E-mail: [email protected];
Cheremushkina Natalia Vasilievna - Candidate of Medical Sciences, Assistant of the Department of Propaedeutics of Internal Diseases and Gastroenterology of MGMSU. e-mail: [email protected]

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Drotaverin as a modern antispasmodic

Many diseases manifest themselves as spasms of individual muscle fibers or a whole group of muscles. In this case, there is a deterioration in nutrition of cells and tissues, oxygen starvation occurs, and these conditions can lead to the development of a serious pathological process. The intensity of the pain syndrome is different for different conditions.In such situations, resort to the use of antispasmodics, which have an analgesic effect, that is, they act on the pain and spasm etiopathogenically and symptomatically.

With a decrease in spasm normal physiological circulation and the work of tissues and organs is restored:

  • Improves the progress of food through the intestines;
  • Improves the excretion of pancreatic juices;
  • Improves blood circulation of internal organs;
  • Improved excretion of urine.

Spastic pains most often occur when the work of the gastrointestinal tract is disrupted. Due to the spastic condition of smooth muscle cells, many known symptoms occur.

In addition to diseases of the gastrointestinal tract, spastic pains appear in diseases of the genitourinary system.

A variety of antispasmodics

Many drugs have antispasmodic activity. They have different mechanisms of action and, according to this, are divided into 2 groups:

Neurotropic spasmolytics

This group of drugs has an effect on the vegetative ganglia, or rather, actually on the transmission of nerve impulses, which produce stimulation of smooth muscles. One of the main antispasmodics of this group are M-holinoblokatory.

M-holinoblokatory influence on muscle tissue in various ways:

  • Reducing the tone of smooth muscles of internal organs - bile ducts, gastrointestinal tract, urinary tract, bronchi;
  • Increase the heart rate;
  • Promotes mydriasis and spasm of accommodation;
  • Increase intraocular pressure.

On the GI tract, M-cholinolytics do not have equivalent effects.For example, in the upper gastrointestinal tract, the muscle tone of the stomach, gallbladder, pyloric sphincter, duodenum decreases.This is because the M-cholinergic receptors are unevenly distributed.

Quaternary ammonium compounds, in particular, hyoscine butyl bromide, are more selective in their action. However, they have a very low systemic bioavailability. Hyoscine butyl bromide mainly affects the receptors that are located in the upper gastrointestinal tract and in the pancreatobiliary tract. Also, this drug has a ganglion-blocking effect on H-cholinergic receptors.

In the lower parts of the digestive tract, the drug acts at a dosage 10 times higher than the therapeutic dose. The selectivity of this drug is relative, as the selectivity is lost when the dose is raised.

Cholinolytics are used for pain in the abdomen, which is caused by:

  • Dyskinesia of bile ducts;
  • Pylorospasm;
  • Dysfunction of the sphincter of Oddi.

Hyoscine butyl bromide is still poorly effective in renal and biliary colic and should be used with analgesic components.

Spasmolytics of myotropic action

This group of pharmacological agents directly affects the processes occurring in the muscles:

The first mechanism is realized by inhibitors of phosphodiesterase (PDE) - papaverine anddrotaverina hydrochloride. The second mechanism is used by pinasterum bromide and otilonium bromide. The third remains mebeverina hydrochloride.

Myotropic antispasmodics affect certain targets. For example, only on the smooth muscle tissue of the gastrointestinal tract, only the respiratory system or only the vessels.

PDE Inhibitors

This class of antispasmodics is the most universal.In addition to the effect on the digestive and respiratory systems, these drugs have an effect on the cardiovascular. Drotaverin has an effect on PDE of the 4th type, therefore its action is selective, and the spasmolytic effect is characterized by high efficacy. In addition, drotaverin is able to block slow calcium and sodium channels, is a calmodulin antagonist.

Drotaverin can be used for long-term therapy of gastrointestinal diseases with the presence of colicky pains, dyskinesias of bile ducts, with renal colic.

The tolerability of drotaverin is good, since it does not have anticholinergic action. Thus, drotaverin can be prescribed not only for a long time, but also for a wider range of patients. For example, it is widely useddrotaverin in pregnancy .

Calcium antagonists

Otilonium bromide and pinaverium bromide selectively affect the gastrointestinal tract, since their systemic bioavailability is low and is about 10% or less. In this scenario, there are practically no systemic side effects. These drugs have the same spasmolytic effect on the upper and lower parts of the intestine, on the biliary system. Calcium antagonists in connection with this latitude of action are often used in irritable bowel syndrome.

Sodium channel blockers

This group includes mebeverine hydrochloride. In addition to preventing exposure to the sodium cell, the drug blocks the entry into the cell and calcium. These two mechanisms complement each other and increase the spasmolytic effect. Mebeverina hydrochloride is used mainly for functional abnormalities of the digestive tract.

Studies of the effectiveness of drotaverine (No-shpy) in gastroenterological practice

The first studies, which were conducted under the control of placebo, showed that the drug is effective for relieving spasms of the biliary tract, with renal colic and diseases of the stomach and intestines. Two thirds of the patients felt better with drotaverine.

In another study, a positive effect was found in the relief of spasmodic pains during ulcerative diseases of the stomach and duodenum, and the onset of the effect occurred at 5-6 minutes after admission preparation. If patients took no-shp for 20 days, the pain syndrome disappeared completely.

Shanghai Study

In 1998, a study was conducted in Shanghai, where the efficacy of atropine and drotaverin was compared for abdominal pains against the background of gastrointestinal diseases and the biliary system. Drotaverin was used in a dose of 40 mg, and atropine in a dose, mg.With the use of drotaverin, the pain syndrome was significantly more rapid than with atropine.In addition, drotaverin was much more easily tolerated than atropine.

Drotaverine has a more rapid effect, as the pharmacokinetics of it are much better. The therapeutic concentration of the drug in the blood is reached 45-60 minutes after taking the drug.

But-shpa with irritable bowel syndrome (IBS)

IBS is often treated with spasmolytic drugs, moreover spasmolytics are used in all clinical variants of this syndrome. Pain syndrome in IBS is not the main symptom.

Studies using drotaverine, or no-shpy in IBS, showed that in 47% of cases the pain syndrome disappeared compared to 3% in the placebo group.

Drotaverine is an effective drug in gastroenterological practice for relief of pain and spasms in diseases with increased tone of smooth muscles, andprice of drotaverineremains much lower than other drugs from the class of antispasmodics.

Irritable bowel syndrome and colitis: how to help yourself

Irritable bowel syndrome is a fairly common problem that can affect people, regardless of their gender, age or race. Colitis is also a common pathology. What are the effective ways to cope with the negative manifestations of these diseases currently exist?

Relevance of the problem

According to statistical data, irritable bowel syndrome (IBS) affects approximately 15% of the population of our planet. At the same time, recent epidemiological studies show that only one third of people suffering from IBS actively consult with doctors, and only 1% of them come to the receptionist, while others try to cope with the negative manifestations of this pathology. Despite the fact that IBS is a functional disorder that does not affect the death rate, people who suffer from this disorder have a significantly reduced level of quality of life.

Colitis is a pathology of the colon of an inflammatory nature, which can be caused by various negative factors - Pathogenic microorganisms, inorganic poisons, poor-quality products, etc. In some cases, colitis can develop due to hypersensitivity to certain food substances (allergic colitis) or disorders of nervous regulation intestines. Symptoms of colitis, as well as IBS, can significantly reduce the patient's quality of life. That is why these two pathologies require timely and justified treatment.

Modern effective remedy for IBS and colitis

Depending on the cause that caused the development of colitis, the patient is prescribed etiologic treatment. In irritable bowel syndrome, treatment is generally symptomatic, since the exact organic cause of this pathology has not been established to date. An important role in the development of symptoms of colitis and IBS is a spasm of smooth muscle in the intestine. Therefore, it is reasonable to use antispasmodic drugs to eliminate manifestations of these pathologies.

One of the most effective modern antispasmodics is a medicinal preparationMebsin Retard. The active substance of this drug is mebeverin - myotropic antispasmodic with a selective effect on the musculature of the digestive tract. Mebeverin is able to eliminate spasms of the intestines without inhibiting its normal motor skills.

A drugMebsin Retardis indicated for use with a feeling of discomfort in the abdomen, intestinal disorders, abdominal pains and spasms accompanying irritable bowel syndrome. Also, this drug is used to eliminate spasms of the digestive tract of secondary origin, which are caused by organic diseases.

Mebsin Retardis a safe antispasmodic: its active substance affects only the intestines and the biliary system, which minimizes the risk of developing systemic adverse reactions. The active substance of this preparation is placed in a capsule with an acid-resistant coating, which also has a semi-impermeable membrane that promotes the release of mebeverine for 16 hours all over intestines. This ensures a prolonged spasmolytic effect.

Generally,Mebsin Retardis a safe antispasmodic, which has a convenient mode of use, allows you to quickly eliminate the negative symptoms of IBS and colitis, and provide a lasting effect.

For accommodation in specialized publications intended for medical institutions and doctors: Mebsin Retard (Mebsin Retard®) Registration Certificate of the Ministry of Health of Ukraine No. UA / 8968/01/01. Order of the Ministry of Health of Ukraine No. 32 of 26.01. in Keep out of the reach of children. Full information on the use of medicines and a full list of side effects is contained in the instructions for medical use by reference (2).



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