Elobixibat inhibits the IBAT expressed on the epithelial cells at the terminal ileum to inhibit bile acid reabsorption, thereby increasing the amount of bile acids flowing into the lumen of the large intestine. Since bile acids induce secretion of fluid into the large intestinal lumen and promotes gastrointestinal motility, elobixibat exerts its therapeutic effect on constipation through dual actions, i.e., secretion of fluid and promotion of large intestinal motility.

CFTR: Cystic fibrosis transmembrane conductance regulator, TGR5: Transmembrane G protein-coupled receptor, AC: Adenylate cyclase, ATP: Adenosine triphosphate, cAMP: cyclic adenosine monophosphate, PKA: Protein kinase A, 5-HT: Serotonin, IPAN: Intrinsic primary afferent neuron (It is thought to be the sensory nerve that is localized in the enteric plexus and detects mechanical and chemical stimuli to the gastrointestinal tract.), ACh: Acetylcholine, NO: Nitric oxide

Editorial review: Professor Noriaki Manabe, Endoscopy and Ultrasound Center, Kawasaki Medical University