THE ROLE OF MEBEVERINE

IN
IRRITABLE BOWEL SYNDROME

NASRUL ZUBIR
DIVISION OF GASTROENTERO-HEPATOLOGY
DEPARTMENT OF INTERNAL MEDICINE FACULTY OF MEDICINE
ANDALAS UNIVERSITY PADANG
 INTRODUCTION
 Irritable bowel syndrome (IBS) , is a group of symptoms including abdominal
pain and changes In pattern of bowel movement without any evidence of
underlying damage
 These symptoms occur over a long time ,often years. It has been classified
into four main tipes IBS-C, IBS-D, IBS-M, IBS-U .
 Pathophysiology of IBS is not entirely decrypted, but evidence of multiple
pathogenic , abnormal motor function, psychological factors, and
impairment of enteric nervous system and brain-gut axis.
 There is known cure of IBS, Treatment is carried out to improve symptoms.
This may include dietary, medication, probiotic and conseling. The
medication may be to help.
 Used to help with diarrhea or constipation.
 Dietary measure include increase soluble fiber intake, a gluten free diet, or
short-term diet low in fermentable oligoccharides, disaccharides,
monosaccharides and polyols ( FODMAPs)
Mechanism
 Genetic, envirommental, and psychological
factors seem to be important in the
development of IBS.
 There is evidence that abnormalities accur in
the gut flora of individual who have IBS, such
as reduce decrease in bacteria Bacteroidetes
and increase of Furmicutes.
 Psychological stress can induce increased
inflammation and there by cause IBS.
 Mechanisms of IBS
 1. Dietary disorder
 2 Motility disorder
 3. Neurologigal disorder
 4. Sensory abnormality
 5. Abnormality of gut-brain interaction
 IBS: Symptoms

 Chronically recurring symptoms

- abdominal pain
- altered bowel function
- urgency to defecate
- bloating
- feeling of incomplete evacuation
 Not explained by structural or known
biochemical abnormalities
 IBS: Bothersome symptoms

200
36%
160
28%
Patients

120 22%
12%
80

40
1%
0
Abdominal Urgency Bloating Mucus in stool Number of bowel
pain/discomfort movements

Parameters

Northcutt et al, 1999

 IBS: Altered bowel
function
Neither diarrhoea or
constipation
Diarrhoea-predominant
21%
31%

27%
Alternating diarrhoea/ 21%
constipation
Constipation-predominant

Jones et al, 1992

 Stool form Appearance
type
 Separate hard lumps,like nuts
 (hard to pass) . Result of slow 1
 Transit
2
 Sausage-shaped but lumpy

 Like a sausage but with crack 3

 On its surface

 Like a sausage or snake smooth 4
 And soft

 Soft blobs with clear cut edges 5

 ( easy to pass )

 Fluffy pieces with ragged edges 6

 A mushy stool

 Watery , no solid pieces.Result 7

 Of very fast transit

Bristol
IBS: Quality of life (QOL)
Comparison with other diseases
90
National normative
value
80

Mean 70 Diabetes type II

SF-36
60 IBS
score
50

40
Clinical depression
30

Wells et al, 1997

Etiology

 While the cause of IBS are still unknown ,it is

believed that the entire gut-brain axis is
effected.
 The risk of developing IBS increases six-fold
after acute gastroenteritis infection.
Postinfection ,fucher risk factors are young
age, prolonged fever,anxiety, and depression.
 Post-infection , Stress, Bacteria, Fungus,
Protozoa, Vit-D deficiency, Genetic
Diagnosis
 No specific laboratory or imaging test can diagnosis IBS.

 The recommendation for physicians are to minimize the use of medical investigation.

 ROME criteriaare usually used.

The Rome IV criteria includes recurrent abdominal
pain,on average, at least 1 day/week in the last 3
moonths,associated with two or mor of the following
criteria:
- Related to defecation
- Associated with a charge in frequency of stool.
- Associated with a change in form of stool

 Viseral hypersensitivity is an important concept in IBS

 Management
A. Psychological & supportif
B. Dietetic
C. Treatment
 Laxativa
 Antidiarrhea
 Prokinetic
 Selektif HT-3 Receptor Antagonist
 Antispasmodic
 Effication OB in decrease diarrhea
* p=0.022 * p=0.048
50
% penurunan kejadian diare dari

40
kondisi awal pasien

30
Otilonium bromide
20 Placebo

10

0
5 minggu 10 minggu 15 minggu

Glende et al. Eur J. Gastr Hepat, 2002; 14:1331-1338

Management of IBS

 Diet
 Fiber
 Medication
- Laxatives
- Antispasmodics
- Discontinuation of PPI
 Probiotics
 Psychological therapies
 Discuss dietary
changes :
 Give “ lifestyle and food in
in IBS”patient information
leaflet.
 Low FODMAP diet
Medication for treatment IBS
 Antispasmodics may help with pain but likely to help
bloating
@ Pepermin oil capsules ( 1-2 caps tid
before meals)
@ Otilonium bromide (OB) ( 40 mg bid)
@ Hyoscine butylbromide ( 20 mg qid)
@ MEBEVERINE ( 135 mg tid before meals ) for 2-3 wks
Mebeverine is adrug used to alleviate
some of the symptoms of IBS, it works
relaxing the muscle in and around the
gut and without cardiovascular actions.
 Do not use lactulose as this broken down by bacteria
causing,bloating and cramping
 For diarrhoea ,loparamide as first line antimotility agent
 For Constipation
- First-line offer the softener laxative docu
sate.
- Second line add in macrogol ( to often)
and bisacodyl to aim for a soft well-
formed stool ( Bristol stool chart type 4)
- Third-line : only consider linaclotine.
 Conclusions
 Irritable bowel syndrome is a chronic functional gastrointestinal
disorder that present with abdominal pain, related defecation,
accompanied by a change on stool frequency or form.
Despite its impact on a patient QOL, it no effect on mortality .

 Manipulating diet ,is an appropriate initial treatment for IBS.A

low FODMAP diet is an effective therapy

 Low dose antidepressants improve symptoms but can be

accompanied by adverse effect.

 Mebeverine is widely used in therapy for IBS, antispasmodic

without cardiovascular actions.
THANK YOU