Existing and emerging therapies for managing constipation and diarrhea

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HIGHLIGHTSFor constipation and diarrhea, stepwise therapy is recommended.When initial therapy is unsuccessful:Secretagogues and 5-HT4 receptor agonists are used for chronic constipation.Bile-acid binding agents, eluxadoline, and rifaximin are used to treat diarrhea.Several newer compounds are being developed and tested in clinical trials.Functional bowel disorders (i.e., constipation and diarrhea) are characterized by abdominal pain, bloating, distention, and/or bowel habit abnormalities in the absence of obvious anatomic or physiologic abnormalities on routine diagnostic tests. These symptoms are attributable to gastrointestinal sensorimotor dysfunctions resulting from peripheral and/or central mechanisms. Available drugs target the underlying bowel disturbance (i.e., constipation, diarrhea, or both), supplemented when necessary by management of pain. Osmotic and stimulant laxatives, secretagogues, and serotonin 5-HT4 receptor agonists are approved for treating constipation. Loperamide, anticholinergic agents, rifaximin, bile-acid binding agents, eluxadoline, and clonidine are used to treat diarrhea. Several exciting new compounds, some of which have been evaluated in humans, are currently under development.

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