Background & Aims

Central neuromodulators (antidepressants, antipsychotics, and other central nervous system−targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut−brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations.

Methods

The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee.

Results

The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6−12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient−provider relationship.

Conclusions

Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations.

中文翻译：

---

用于功能性胃肠道疾病（肠道与大脑相互作用的疾病）的神经调节剂：罗马基金会工作组报告

背景与目标

中枢神经调节剂（抗抑郁药，抗精神病药和其他针对中枢神经系统的药物）被越来越多地用于治疗功能性胃肠道疾病（FGIDs），现在被认为是肠脑相互作用疾病。但是，在这些情况下使用中枢神经调节剂的现有证据和指南很少且不完整。在这份罗马基金会工作小组的报告中，一个多学科小组总结了可用的研究证据和临床经验，以提供指导和治疗建议。

方法

工作小组总结了有关中枢神经调节剂的药理作用及其对胃肠道感觉运动功能的影响的文献，并对它们用于治疗FGID综合征的方法进行了循证审查。由于缺乏FGID的数据，我们纳入了非胃肠道疼痛性疾病以及疼痛，恶心和呕吐的特定症状的数据。该信息被合并到最终文件中，该文件包括在委员会专家的研究和临床经验的指导下，可用于临床的证据和建议的综合。

结果

FGID中神经调节剂的基于证据的审查受有限的可用对照试验的限制，与开放标签研究和病例系列以及专家的经验相结合，以使用共识（Delphi）方法提出建议。由于条件的多样性和治疗方案的复杂性，针对不同的FGIDs提出了具体的建议。但是，一些一般性建议包括：（1）低至中等剂量的三环类抗抑郁药可提供最有说服力的证据证明对治疗慢性胃肠道疼痛有好处，并且还建议使用痛苦的FGIDs和5-羟色胺去甲肾上腺素再摄取抑制剂，尽管还需要进一步研究；（2）增强，即增加第二种治疗方法（加入喹硫平，阿立哌唑，当单一药物治疗失败或以更高的剂量产生副作用时，建议使用丁螺环酮α2δ配体药物。（3）治疗应持续6-12个月，以防止复发；（4）成功治疗的实施需要有效的沟通技巧，以提高患者的接受度和依从性，并优化患者与提供者之间的关系。

结论

基于系统的，有选择的集中审查以及多学科小组的共识，我们提供了使用中枢神经调节剂治疗慢性胃肠道症状和FGID的摘要信息和指南。需要进一步研究以确认和完善这些建议。