Psychotropics, Antidepressants, and Visceral Analgesics in Functional Gastrointestinal Disorders

Douglas A. Drossman,Hans Törnblom

doi:10.1007/s11894-018-0664-3

Abstract

Purpose of ReviewThe functional gastrointestinal disorders, or disorders of gut-brain interaction as defined by the Rome IV criteria, are the most common diagnostic entities in gastroenterology. Treatments that address the dysregulation of gut-brain interaction with these disorders are increasingly gaining interest as a better option than for example traditional analgesics, particularly opioids. Antidepressants, antianxiety and antipsychotic medications, and visceral analgesics, now termed neuromodulators, are included in this update addressing the evidence of treatment benefit in disorders of brain-gut interaction.Recent FindingsBy a careful selection based on a multidimensional clinical profile, a decreased symptom burden, particularly regarding abdominal pain, nausea, and vomiting, as well as improved social function and quality of life, can be obtained by use of neuromodulators. There is good evidence for the peripheral neuromodulators from studies in bowel disorders, and the central neuromodulators both from indirect evidence in chronic pain disorders as well as selected disorders of brain-gut interaction.SummaryBasic knowledge about the pharmacologic properties and clinical use of neuromodulators in disorders of brain-gut interaction improves the treatment outcome and avoids use of traditional analgesics.

Highlights

The functional gastrointestinal disorders (FGIDs) are currently defined by the Rome IV criteria [1] and include 33 different diagnostic entities in adults where neurogastroenterological interactions are increasingly highlighted as a central pathophysiologic mechanism
There is good evidence that treatment modalities addressing this association should be an integral part of the approach to the patient who experiences troublesome disorders of gut-brain interactions (DGBIs) symptoms
In order to avoid the stigma connected with some of the pharmacologic treatment modalities, such as antidepressants, antipsychotics, or other psychotropic terminologies, a recent Rome Foundation working team report [2] introduced the term neuromodulators with the intention to put more focus on the neurologic interaction relating to treatment, rather than the historical term targeted at psychiatric disorders

Summary

Introduction

The functional gastrointestinal disorders (FGIDs) are currently defined by the Rome IV criteria [1] and include 33 different diagnostic entities in adults where neurogastroenterological interactions are increasingly highlighted as a central pathophysiologic mechanism.

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Conclusions

Findings

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