Review article

Pharmacotherapy for intestinal motor and sensory disorders☆

Medications that increase motor activity or promote propulsion

Stimulation of gut propulsion can be effected by medications that bind to several disparate receptor subtypes. In general, most prokinetic drugs are postulated to act on enteric nerve pathways, although some agents exhibit direct action on gut smooth muscle.

Medications that inhibit motor activity or slow propulsion

Several medications that blunt exaggerated motor activity or delay transit serve useful therapeutic roles in a diverse range of disorders of gut function. As with the prokinetic drugs, most agents with inhibitory actions on gastrointestinal motility exert their effects on enteric nerve pathways.

Medications that blunt visceral sensation

Abnormalities of visceral sensation have been postulated as causative factors in IBS, functional dyspepsia, and noncardiac chest pain. Patients with these three syndromes exhibit heightened sensation to balloon distention of the colorectum, stomach, and esophagus, respectively [81]. Furthermore, some individuals with functional bowel disorders show hyperalgesic responses to stimulation in several different regions of the gastrointestinal tract indicating a shared pathogenesis.

As a consequence

Drugs acting by mechanisms other than modulation of gut motor or sensory activity

Although medications to modulate gut motor and sensory activity theoretically are attractive from a pathophysiologic standpoint, many patients with motility or functional disorders benefit from initiation of therapies that act by unrelated mechanisms. In some cases, food-based treatments reduce symptoms. As examples, fiber supplements improve symptoms in constipation-predominant IBS, whereas guar gum can reduce manifestations of dumping syndrome. Medications without effects on visceral motility