[The Usefulness of Neuromodulators in Clinical Practice: The Gastroenterologist's Viewpoint].

Abstract

Neuromodulators have become a fundamental tool in modern gastroenterology, particularly for disorders involving brain-gut interaction. Originally developed for the management of psychiatric disorders, these drugs have demonstrated the ability to modulate visceral pain, intestinal hypersensitivity, and gastrointestinal motility, acting through both central and peripheral mechanisms. The most widely used neuromodulators included tricyclic antidepressants, which are effective in reducing abdominal pain; selective serotonin reuptake inhibitors, which are useful for patients with comorbid anxiety or depression; and serotonin-norepinephrine reuptake inhibitors, which are used for visceral pain with neuropathic features. Other drugs, such as gabapentinoids, mirtazapine, buspirone, and certain antipsychotics, have also shown benefits in specific phenotypes. Drug selection depends on the patient´s clinical profile, comorbidities, tolerability, and risk of adverse effects, particularly for elderly and polymedicated patients. Neuromodulator management is characterized by the use of low initial doses with gradual increases and close patient monitoring. In addition, a multidisciplinary approach integrating non-pharmacological interventions such as cognitive-behavioral therapy, gut-directed hypnotherapy, and mindfulness-based programs, is recommended. This combination enhances clinical effectiveness, reduces stigma, and improves quality of life, consolidating neuromodulators as an essential part of the comprehensive treatment of disorders of brain-gut interaction.