Approaches to the Modulation of Abdominal Pain
Despite their high prevalence and significant economic impact on the health care system, functional gastrointestinal disorders have evaded successful therapy. Conventional medical therapies are based on inadequate disease models, and the great majority of published treatment trials are flawed in the...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
1999-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/1999/416576 |
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| Summary: | Despite their high prevalence and significant economic
impact on the health care system, functional gastrointestinal
disorders have evaded successful therapy. Conventional
medical therapies are based on inadequate disease models, and the
great majority of published treatment trials are flawed in their design,
permitting no conclusions to be drawn about the true efficacy
of any particular treatment. During the past several years, a new,
comprehensive disease model based on alterations in brain-gut interactions
has rapidly evolved. Even though the precise mechanisms
and sites underlying these alterations remain incompletely
understood, plausible targets for the development of effective
pharmacological treatments are receptors on peripheral terminals
of visceral afferent nerves (opioids and serotonin), ion channels
and receptors on dorsal horn neurons within the spinal cord
(opioids, glutamate, calcitonin gene-related peptide and
neurokinin-1), and supraspinal targets in the brainstem within
the limbic system and in the prefrontal cortex (serotonin, catecholamines,
dopamine and acetylcholine). Regardless of the primary
pathophysiology underlying functional gastrointestinal
disorders (ie, central versus peripheral), different pharmacological
strategies targeted at different sites in the periphery or within the
central nervous system may become effective therapies in the future. |
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| ISSN: | 0835-7900 |