Pharmacotherapy for gastric and intestinal cramping pain: ‎ current and emerging therapies

ABSTRACTIntroduction Acute gastrointestinal cramping pain (GICP) is a debilitating condition that affects many people worldwide, significantly reducing their quality of life. As such, prompt treatment is crucial.Areas covered This article will explore relevant literature from databases such as PubMed, Scopus, Google Scholar, Cochrane Library, and Web of Science. Additionally, we searched ClinicalTrials.gov and the WHO ICTRP database for the latest clinical trials.Expert opinion Consensus dictates that antispasmodics such as hyoscine-N-butyl bromide and mebeverine should be the primary treatment for GICP. If these prove ineffective, patients can switch to an antispasmodic with a different mode of action or add acetaminophen/NSAIDs for more severe cases. Currently, several antispasmodics are undergoing clinical trials, including drotaverine, alverine, pinaverium, otilonium bromide, fenoverine, tiropramide, otilonium bromide, trimebutine, and peppermint oil. Well-designed head-to-head studies are necessary to evaluate current antispasmodics’ safety, efficacy, pharmacokinetic, and pharmacoeconomics profiles. Recent studies have shown that fixed-dose combinations of antispasmodics + NSAIDs or two different antispasmodics can improve patient compliance and synergistically reduce GICP. Therefore, it is recommended that the global availability and accessibility of these products be enhanced.KEYWORDS: Antispasmodiccrampsfunctional gastrointestinal disordergastric painhyoscinemebeverinespasmspasmolytic Article highlights Dealing with gastric and intestinal cramping pain (GICP) can be difficult due to the lack of a clear definition and global guidelines for managing this symptom, as well as poorly designed clinical studies.However, there are effective treatments available. The first line of treatment for GICP is antispasmodics such as hyoscine-N-butyl bromide and mebeverine. If these do not work, trying a different antispasmodic with another mechanism of action and adding NSAIDs/acetaminophen can be helpful.For centrally-mediated GICP, low-dose tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or melatonin may be helpful.There are also new therapies emerging for managing GICP, like selective 5-HT3 antagonists, guanylate cyclase-C receptor agonists, fixed-dose combinations of antispasmodics and NSAIDs, or two antispasmodics.To improve the management of GICP and enhance the quality of life for those affected, we recommend conducting well-designed clinical studies and economic evaluations comparing the efficacy, safety, pharmacokinetic, and pharmacoeconomic profiles of available antispasmodics, developing GI-restricted, multi-target antispasmodics, or improving the pharmacokinetic profile of current agents.Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.