Abstract. – Objective: Aimofthisreviewis tosummarizethestudiescarriedout,withparticu- lar interest in those who dealt with otilonium bro- mide, in treatment of IBS (Irritable Bowel Syn- drome). Discussion: IBS is a frequent gastrointestinal disease, characterized by a combination of sever- alsymptomsincludingabdominalpainordiscom- fort, flatulence and problems related to bowel habits (constipation and/or diarrhea). It affects about15%ofthewesternpopulation,withanega- tiveimpactonthequalityoflifeandalsoonhealth carecosts.Inrelationtosuchimportantcomplexi- ty and negative impact, therapeutic options are still very limited and most of the pharmacological compounds,validatedforshorttermuse,areonly partially controlling symptoms. Among those, an- ti-spasmodics are commonly used in clinical set- tings. Despite a discrete literature in support of thesedrugs,systematiccollectionsofclinicalevi- dence to support the use of anti-spasmodics and in particular the use of otilonium bromide in courseofIBSarescarce. Results and Conclusions: Otiloniumbromideis a systemically poorly absorbed antispasmodic, whichhasshownclearefficacycomparedtoplace- bo,incontrollingsymptomsrelatedtoIBS.Otiloni- um bromide was effective also in comparison to other drugs, such as pinaverium bromide and mebeverine,withafavorabletolerabilityprofile.Fur- therstudiesarenecessarytobetterdefineduration oftreatmentandmaximumtherapeuticdose. Key Words: Irritable bowel syndrome, Anti-spasmodics, Otiloni- um bromide. Introduction Irritable bowel syndrome (IBS) represents the most frequently encountered functional digestive European Reviewfor Medicaland Pharmacological Sciences The use of anti-spasmodics in the treatment of irritable bowel syndrome: focus on otilonium bromide F. FORTE, M. PIZZOFERRATO, L. LOPETUSO, F. SCALDAFERRI Department of Internal Medicine, Division of Gastroenterology, School of Medicine, Catholic University of the Sacred Heart, Rome (Italy) Corresponding Author: Franco Scaldaferri, MD; e-mail: francoscaldaferri@gmail.com 25 disorder in gastroenterology practice. It is char- acterized by an inconstant association of symp- toms like abdominal pain or discomfort associat- ed with disorders of bowel movement (constipa- tion or diarrhea) and/or or symptoms such as bloating and abdominal distension. The social impact of this disease is significantly high, with importantlimitationinqualityoflifeandproduc- tivity, increased absenteeism from work and rele- vant costs for health systems because of repeti- tivediagnostictestandtherapies 1-3 .IBSisacom- plex disease, in which the wide range of symp- tomscannotbealwaysattributedtothenumerous pathological mechanisms hypothesized. That is the main reason of the lacking of an appropriate specificetiologictherapy 2,3 . Epidemiology and Pathogenesis of IBS Precise estimation of IBS epidemiology is complex due to several reasons: the variety of factors involved in its pathogenesis, the diagnos- tic difficulties due to the absence of specific and reproducible examinations or markers, the vari- ety of used criteria, the variability of clinical manifestations as well as the division of medical management in self-medication (71-80%), family medicine (20-29%) and referral centers (1%), in the absence of a common database. Despite this, it is commonly recognized that IBS is a wide- spread disease, with high prevalence in western countries and in women (M/F 1:2) 1,4 . Prevalence of the disease depends on the diagnostic criteria used 1,3 ,varyingfrom2.5%,whenconsideringon- ly 1 of the 6 Manning’s criteria described below, to37%adoptingall6criteria 1 or10%with3cri- teria 1 . It is generally accepted, however, that IBS affects 10-15% of western population 2,3,5,6 . His- torically IBS has been considered a functional is- sue, without any clear evidence of anatomical or metabolic or inflammatory or infectious damage, 2012;16:25-37