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Why do we have so few effective drugs for irritable bowel syndrome? A European perspective

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 436–437 (2005)Cite this article

Irritable bowel syndrome (IBS) is a common, non-life-threatening disorder which can nevertheless result in significant debility and impairment of quality of life for affected individuals. For decades, few studies were carried out in IBS and the syndrome was regarded as little more than a nuisance, or the preserve of the anxious or neurotic. These days have now passed and we enjoy a much greater appreciation of the true prevalence, as well as the physical, psychological and socioeconomic impact, of IBS and have made some progress towards understanding the pathogenesis of its symptoms.1 The pharmaceutical industry has not been slow to appreciate the prevalence of IBS and the potential windfall attendant upon a successful drug launch in this area; recent community surveys suggest that IBS affects 9% of the adult population in Western Europe.2Why then does the drug cupboard remain so bare in Europe?

Many of the factors that retard drug development in IBS are common throughout the world and relate to the very nature of the disorder itself. Among the list of IBS phenomena 'sans frontières' are its heterogeneity and the challenges inherent to a symptom-based diagnosis. Any population of IBS subjects will include some individuals whose primary complaint is pain, and others whose main concern is bloating. The nature of the alteration in bowel habit that accompanies these symptoms, which is so fundamental to the concept of IBS, will also vary—some patients will be constipated, others will have diarrhea, and many will alternate between these extremes of bowel consistency and frequency. These factors significantly influence patient responses to some of the newer drugs. Clinicians are but scratching the surface in their understanding of IBS heterogeneity—will specific remedies be required for patients with predominant bloating, post-infectious IBS,3 or for those IBS patients who seem to harbor bacterial overgrowth4 or subtle colonic inflammation?5

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  1. Professor of Medicine and Human Physiology and Head of the Medical School at the National University of Ireland, Cork, Ireland

    Eamonn MM Quigley

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  1. Eamonn MM Quigley
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Quigley, E. Why do we have so few effective drugs for irritable bowel syndrome? A European perspective. Nat Rev Gastroenterol Hepatol 2, 436–437 (2005). https://doi.org/10.1038/ncpgasthep0292

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