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Complementary and Alternative Medicine Use by Patients With Gastrointestinal Diseases. new
#141616 - 01/23/05 04:56 PM

February 2005, 39:2

The Incidence of Self-prescribed Oral Complementary and Alternative Medicine Use by Patients With Gastrointestinal Diseases.

Journal of Clinical Gastroenterology. 39(2):138-141, February 2005.

Kong, San Choon MRCP *; Hurlstone, David P MRCP, MD *; Pocock, Charlotte Y MB, ChB *; Walkington, Lucy A MB, ChB *; Farquharson, Nina R MB, ChB *; Bramble, Michael G MD, FRCP +; McAlindon, Mark E MD, FRCP *; Sanders, David S MRCP, MD, FACG *

Abstract:
Goals: To assess the incidence of oral complementary and alternative medicine (CAM) usage by gastroenterology patients at a single university center and compare against controls.

Background: The public awareness and usage of CAM have increased. The use of CAM has been described in patients with functional bowel disorders; however, their role in patients with gastrointestinal disease is less clear.

Study: Patients attending luminal gastroenterology clinics and customers at local supermarkets completed a 30-point, structured questionnaire assessing their use of CAM.

Results: A total of 1,409 subjects were recruited. The incidence of CAM use was 49.5% for inflammatory bowel disease, 50.9% for irritable bowel syndrome, 20% for general gastrointestinal diseases, and 27% for controls. Pearson's [chi]2 tests showed that patients with inflammatory bowel disease (IBD) or irritable bowel syndrome were more likely to use CAM than controls (P < 0.001). Binary logistic regression analysis showed that females were more likely to take CAM than men (P < 0.05).

Conclusions: The percentage of CAM users among patients with IBD is similar to those with a functional diagnosis. Increasing numbers of IBD patients are using CAM in addition to conventional therapy. Awareness of this may prevent adverse CAM and conventional drug interactions.

(C) 2005 Lippincott Williams & Wilkins, Inc.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=1139747&specid=13&ok=yes

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"Good" Bacteria Help Irritable Bowel Syndrome as much as Zelnorm and Lotronex new
#168751 - 04/10/05 06:34 PM

31/03/2005 - A drink containing a probiotic strain isolated from infants relieved symptoms of irritable bowel syndrome to the same extent as pharmaceutical treatments for the condition, report Irish researchers.

The team from the Alimentary Pharmabiotic Centre, set up last year at Irelands University College Cork to investigate bacteria and gut health, found that patients who consumed a malted milk drink containing Bifidobacterium infantis 35624 everyday for eight weeks experienced fewer overall symptoms, abdominal pain and discomfort.
The symptom relief was comparable to that seen with Zelnorm (tegaserod) and Lotronex (alosetron), drugs that have been recently approved for the treatment of irritable bowel syndrome (IBS).

IBS is a long-term condition that usually involves cramping, diarrhoea and constipation. It affects between 10 and 15 per cent of the Irish population and a similar proportion of people in other western countries.

However the precise cause of IBS is not fully understood and there is no cure yet. Treatments are aimed at alleviating symptoms but medication, for those with moderate to severe forms of the disease, does not work for all patients.

Senior author on the new study, Professor Eamon Quigley, who is head of UCCs medical school, said the results "look very good in comparison to pharmacological products".

"We believe we have very significant results. It is at least as effective as lots of available products, and probiotics have a good safety profile too," he told NutraIngredients.com.

In contrast, treatment with another probiotic bacteria, Lactobacillus salivarius UCC4331, also isolated at the Irish centre, appeared to have no more effect on IBS symptoms than a placebo drink.

Both strains, patented by UCC, had shown interesting properties in laboratory studies.

Previous studies of probiotic preparations have been small and used different probiotics, different doses and different definitions of IBS. Ours is one of the first properly powered trials conducted to accepted standards in this area, Dr Quigley added.

For the study, published in the March issue of Gastroenterology (vol 128, issue 3, pp541-51), 77 people with IBS were asked to drink a malted milk drink every morning. The drink either contained L. salivarius, B. infantis or no added bacteria. The subjects recorded their symptoms.

Our hypothesis is that low-grade inflammation is a factor in IBS and that certain probiotic bacteria can reduce this inflammation. We have some evidence to support this theory because our paper shows a change in cytokine ratios after the probiotic treatment," said Dr Quigley.

He added that further clinical trials are ongoing and research into the mechanism will also be carried out by the team.

Neither of the strains is currently commercially available but the APC works in partnership with Procter and Gamble and is hoping to bring the bacteria to market in new products.

http://www.foodnavigator.com/news/news-ng.asp?n=59070-probiotic-bacteria-helps

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Fiber's New Role in Type 2 Diabetes new
#183761 - 06/05/05 05:28 PM

Fiber's New Role in Type 2 Diabetes: Helping Prevent Heart Disease


By Greg Arnold, DC, CSCS, May 3, 2005, abstracted from Fiber supplements may lower cardiovascular risk in type 2 diabetics from an American Heart Association press release April 30, 2005.

For the 16 million Americans with Type 2 Diabetes, health complications are numerous and costly, making up much of the $132 billion spent each year to treat type 2 diabetes.1 From the threat of kidney failure to blindness to nerve damage and foot infections and skin problems,2 type 2 diabetes takes a heavy toll on your health.

Now, a new study3 has found that a relatively simple supplement can help prevent heart disease in type 2 diabetics, perhaps the worst health consequence of the condition.

In the study, researchers had 78 participants with type 2 diabetes take 10g to 15g of an over-the-counter fiber supplement in 5-gram doses two to three times daily 5 to 10 minutes before eating. Total blood cholesterol, triglycerides, LDL (bad cholesterol) and HDL (good cholesterol) were measured at the beginning of the study and at 90 days.

At the end of 90 days, researchers found remarkable results. In addition to observing both total cholesterol and triglyceride levels drop more than 14 percent, LDL levels decreased nearly 29 percent and HDL levels increased 21.8 percent. All of these results have been found to help decrease the risk for heart disease.

Whats more, all the subjects taking the fiber were virtually free of side effects.

But perhaps the most important statement of all made by the researchers was the potential for fiber supplementation to be a viable alternative to statin drugs, the most popular class of cholesterol-lowering drugs.

For the researchers, the study demonstrates that dietary fiber supplements may be an alternative to statins for people with moderately high cholesterol who are unable or unwilling to take statins.

Reference:
1 Hogan, P., T. Dall, et al. (2003). "Economic costs of diabetes in the US in 2002." Diabetes Care 26(3): 917-32

2 Type 2 Diabetes Complications posted on the American Diabetes Association website

3 Fiber supplements may lower cardiovascular risk in type 2 diabetics posted on the American Heart Association website April 30, 2005 www.americanheart.org/presenter.jhtml?identifier=3030591


http://www.nowfoods.com/?action=itemdetail&item_id=45295

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Prebiotic shown to increase bone mineral density new
#183762 - 06/05/05 05:40 PM

Prebiotic shown to increase bone mineral density
02/06/2005 - A daily prebiotic supplement helps to increase bone mineral density, shows new research funded by inulin maker Orafti.

The firms RaftiloseSynergy1, an enriched inulin powder, increased calcium retention and accretion in bones by 15 per cent after a year, reported the firm today.
The findings will be a major boost to the ingredient as food makers seek to offer products to consumers that are increasingly aware of the threat of osteoporosis.

The bone-wasting disease now affects an estimated 75 million people in Europe, USA and Japan, according to the International Osteoporosis Foundation.

Many young girls get as little as 10 per cent of the calcium they need each day, often a result of avoiding dairy products. But by increasing the mineral density of bone in early life and retaining it, osteoporosis risk can be significantly reduced.

Previous studies have shown that taking 8g of Orafti's oligofructose-enriched inulin increased the calcium absorbed from the diet by up to 20 per cent.

The new study, carried out by Professor S.Abrams from the Baylor College of Medicine and the Texas Children's Hospital in Houston, shows a significant 15 per cent increase of calcium retention and accretion within the bones of the 100 girls and boys, aged nine to 13, after one year of supplementation.

Dr Anne Franck, vice president of science and technology at Orafti, said: "If effects are not long-term they have little clinical benefit. The Abrams research is physiologically significant as it provides an insight into the longer-term effect of RaftiloseSynergy1 and demonstrates that it can be highly beneficial in increasing bone mineral density."

She added that standard inulin and oligofructose also improve mineral absorption, but only at higher dosages, so they are not suitable for related health claims.

"With the patented RaftiloseSynergy1, calcium absorption and bone density claims are possible with only 8g/day," said Dr Franck.


For the study, half of the sample was provided with 8g of RaftiloseSynergy1 to consume with breakfast each day for a year, while the other half was provided with a placebo. Prior to the start of the research, all participants underwent measurements of calcium absorption and retention, via blood and urine samples, and bone mineral content and density, via X-ray body scans. These tests were repeated after two months and at the end of the year-long study.

Regular checks were also made on the participants' average daily diet in order to ensure that no significant changes in calcium intake occurred. Calcium intake was maintained throughout the study at usual levels around 900 mg/day.

Dr Franck said: "Absorption of an adequate amount of calcium is particularly important during early adolescence in order to achieve an optimal peak bone mass. In doing this, and by further ensuring that the maximum amount of calcium is retained in the bones throughout adulthood, the chances of developing conditions such as osteoporosis later in life can be reduced."

The short oligofructose fraction in RaftiloseSynergy1 can thoroughly change the flora in the proximal part of the colon, and the more slowly fermented inulin can function as a selective 'fuel' for this modified flora, which is kept metabolically active further in the gut. This selective fermentation pattern results in the production of short chain fatty acids. These acids decrease the pH within the colon, improving the solubility of the calcium present, which is then better absorbed into the body.

http://www.nutraingredients.com/news/ng.asp?id=60406

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Interactions Between Commensal Bacteria and Gut Sensorimotor Function new
#207559 - 08/22/05 04:57 PM

The American Journal of Gastroenterology
Volume 0 Issue 0 - September 2005
doi:10.1111/j.1572-0241.2005.00230.x


Interactions Between Commensal Bacteria and Gut Sensorimotor Function in Health and Disease

Giovanni Barbara, M.D.1, Vincenzo Stanghellini, M.D.1, Giovanni Brandi, M.D.2, Cesare Cremon, M.D.1, Giovanni Di Nardo, M.D.1, Roberto De Giorgio, M.D.1, and Roberto Corinaldesi, M.D.1

Commensal bacteria inhabiting the human intestine (i.e., intestinal microflora) participate in the development and maintenance of gut sensory and motor functions, including the promotion of intestinal propulsive activity. On the other hand, intestinal motility represents one of the major control systems of gut microflora, through the sweeping of excessive bacteria from the lumen. There is emerging evidence indicating that changes in this bidirectional interplay contribute to the pathogenesis of gut diseases, such as small intestinal bacterial overgrowth and intestinal pseudo-obstruction. Recent interest has also been directed to the potential role of intestinal microflora in the pathogenesis of the irritable bowel syndrome. Although the status of intestinal microflora in the irritable bowel syndrome remains unsettled, small intestinal bacterial overgrowth (as detected with breath testing) and increased fermentation of foods with gas production, provide indirect evidence that microflora may contribute to symptom generation in irritable bowel syndrome. The potential benefit of antibiotic and probiotic therapy is currently under investigation and opens new perspectives in irritable bowel syndrome treatment.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=1305132&specid=13&ok=yes

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A probiotic mixture alleviates symptoms in irritable bowel syndrome patients new
#215254 - 09/22/05 04:26 PM

Alimentary Pharmacology & Therapeutics
Volume 22 Issue 5 Page 387 - September 2005
doi:10.1111/j.1365-2036.2005.02579.x


A probiotic mixture alleviates symptoms in irritable bowel syndrome patients: a controlled 6-month intervention

K. KAJANDER*,, K. HATAKKA*, T. POUSSA, M. FRKKILħ & R. KORPELA*,,

Summary

Background: Irritable bowel syndrome is a gastrointestinal disorder of unknown aetiology. The effect of probiotics in this syndrome remains unclear.

Aim: To investigate whether a probiotic mixture containing Lactobacillus rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve Bb99 and Propionibacterium freudenreichii ssp. shermanii JS is effective in alleviating irritable bowel syndrome symptoms.

Methods: A total of 103 patients fulfilling the Rome I or II criteria took part in this 6-month, randomized, double-blind placebo-controlled trial. The patients received a probiotic capsule or a placebo capsule daily. Gastrointestinal symptoms and bowel habits were recorded.

Results: At the end the total symptom score (abdominal pain + distension + flatulence + borborygmi) was 7.7 (95% CI: 13.9 to 1.6) points lower in the probiotic group (P = 0.015). This represents a median reduction of 42% in the symptom score of the probiotic group compared with 6% in the placebo group. In individual symptoms, borborygmi was milder in the probiotic group (P = 0.008), and for the rest of the symptoms there was a non-significant trend.

Conclusions: The results indicate that this probiotic mixture is effective in alleviating irritable bowel syndrome symptoms. Considering the high prevalence of irritable bowel syndrome and the lack of effective therapies, even a slight reduction in symptoms could have positive public health consequences.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=1326908&specid=13&ok=yes

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Melatonin May Reduce the Pain of Irritable Bowel Syndrome new
#221829 - 10/28/05 11:53 AM

Melatonin May Reduce the Pain of Irritable Bowel Syndrome

News Author: Laurie Barclay, MD
CME Author: Dsire Lie, MD, MSEd


Release Date: October 14, 2005;


Oct. 14, 2005 Melatonin may reduce the pain associated with irritable bowel syndrome (IBS), according to the results of a small, double-blind study reported in the October issue of Gut.

Melatonin, a sleep promoting agent, is involved in the regulation of gastrointestinal [GI] motility and sensation, write G. H. Song, MD, from the National University of Singapore, and colleagues. In view of the high prevalence of sleep disturbance in IBS patients, and the possible double effects of melatonin in regulating sleep pattern and bowel function, we hypothesised that melatonin may be useful in the treatment of IBS, and its therapeutic effects might be most evident if it was used in IBS patients who suffer from concomitant sleep disturbance.

In this study, 40 patients with IBS and sleep disturbances were randomized to receive either melatonin (3 mg) or matching placebo at bedtime for two weeks. There were 24 women and 16 men; age range was 20 to 64 years. Assessments immediately before and after treatment included patient-completed bowel, sleep, and psychological questionnaires; rectal manometry; and overnight polysomnography (PSG).

Compared with the placebo group, the melatonin group had a decreased mean abdominal pain score (2.35 vs 0.70; P < .001) and increased mean rectal pain threshold (8.9 vs -1.2 mm Hg; P < .01). Neither group had significant changes after treatment in bloating, stool type, stool frequency, or anxiety and depression scores nor in sleep parameters, including total sleep time, sleep latency, sleep efficiency, sleep onset latency, arousals, duration of stages 1 to 4, rapid eye movement (REM) sleep, and REM onset latency.

Administration of melatonin 3 mg at bedtime for two weeks significantly attenuated abdominal pain and reduced rectal pain sensitivity without improvements in sleep disturbance or psychological distress, the authors write. The findings suggest that the beneficial effects of melatonin on abdominal pain in IBS patients with sleep disturbances are independent of its action on sleep disturbances or psychological profiles.

Study limitations include small sample size, short treatment period, use of only one dose of melatonin, and limited sensitivity of the hospital anxiety and depression scale.

Future studies should focus on therapy with different doses of melatonin, prolonging the treatment period, and using a larger sample size to provide a clearer view of the role of melatonin in IBS and sleep disturbance, the authors conclude.

The authors have disclosed no financial relationships.

Gut. 2005;54:1402-1407

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe the effect of two weeks of melatonin on abdominal pain and rectal pain sensitivity in IBS.
Describe the effect of two weeks of melatonin on sleep disturbances in IBS.
Clinical Context
Sleep disturbance is commonly observed in patients with IBS, occurring in 26% to 55%. Also, patients with IBS have more REM sleep characterized by arousal, according to the current authors. Melatonin is a close derivative of serotonin and is involved in the sleep-wake cycle via the pineal gland. The GI tract is another source of melatonin, which may exert excitatory and inhibitory effects regulating bowel motility. Melatonin may act by improving gut visceral hypersensitivity. The current authors postulated the melatonin supplementation may relieve bowel and sleep disturbances in patients with IBS with an effect on overall symptoms. This is a double-blind, randomized, placebo-controlled trial to examine the efficacy of 3 mg of melatonin once daily on IBS symptoms and sleep disturbances.

Study Highlights
Inclusion criteria were age 20 to 64 years with IBS diagnosis made by an experienced gastroenterologist using Rome II criteria and sleep disturbance, defined as difficulty getting to sleep, awakening at night, and early morning wakening.
Patients had a Pittsburgh sleep quality index (PSQI) score greater than 5 and sleep disturbance at least two nights a week for 12 weeks.
Exclusion criteria were pregnant or breast-feeding, organic GI, hepatic, or other systemic disorders, history of GI surgery, or cerebral disease.
At baseline an IBS symptom scale, hospital anxiety and depression scale, PSQI and Epsworth Sleepiness scale (ESS) were administered to assess bowel, sleep, and psychological functioning.
Patients also underwent rectal manometry to measure squeeze, push, and resting pressures; and overnight PSG at home, which included electroencephalogram, electrooculogram, nasal airflow pressure, electromyogram, and electrocardiogram.
These measures were repeated at the end of the study.
20 patients were randomized to receive 3 mg of melatonin orally at bedtime and 20 patients to identical-appearing placebo.
Mean age was 27 years, one third was men, and two thirds had the constipation or diarrhea subtype of IBS.
All patients completed the study. None reported adverse effects.
Abdominal pain score was significantly reduced in the melatonin vs the placebo group (2.35 vs 0.70; P < .001) after 2 weeks of treatment.
There was greater reduction in abdominal distension, stool frequency, and total bowel symptoms in the melatonin group.
There were no significant differences in stool type, abnormal sensation of defecation, or quality of life between the two groups.
Rectal distension pressures required to induce feelings of urgency and pain were significantly increased in the melatonin (from 18.4 - 23.0 mm Hg and from 24.8 - 33.7 mm Hg, respectively) vs the placebo group.
Distension pressure thresholds for the first sensation of distension or desire to defecate did not change or differ between the 2 groups.
There were no differences in rectal pressures during resting, pushing, or voluntary squeezing conditions between the 2 groups.
Sleep parameters including global PSQI score, sleep quality, latency, duration, efficiency, disturbance, use of sleep medications, and daytime dysfunction were not significantly different between the 2 groups.
ESS scores were similar between the 2 groups.
PSG findings for REM sleep, onset latency, arousal index, and amount of REM vs non-REM sleep were similar between the 2 groups.
Pearls for Practice
Use of 3 mg of melatonin once daily for two weeks in IBS patients is associated with improvement in bowel pain and rectal distension thresholds for urgency and pain but not with a change in stool frequency, type, or quality of life.
Melatonin at 3 mg daily for two weeks is not associated with improvement in sleep disturbance.

Medscape Medical News 2005. 2005 Medscape

http://www.medscape.com/viewarticle/514515?src=mp

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HeatherAdministrator

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Probiotic relieves irritable bowel syndrome new
#224505 - 11/12/05 01:04 PM

Probiotic relieves irritable bowel syndrome

By Karla Gale

NEW YORK (Reuters Health) - A beneficial strain --or "probiotic" of bacteria called Bifidobacterium infantis 35624 stabilizes bowel movement frequency in patients with irritable bowel syndrome (IBS) who experience either constipation or diarrhea, new study findings suggest.

"Prior work done by our group in animal models of IBS clearly showed that this particular strain has potent immune-modulating effects," lead researcher Dr. Eamonn M. M. Quigley told Reuters Health.

He explained that lab animals with ulcerative colitis, and in humans with IBS, treatment with B. infantis 35624 reverses severe inflammation of the colon "and restores the immune balance from a pro-inflammatory state to an anti-inflammatory state."

To determine the impact of the probiotic on bowel movement frequency, Dr. Quigley, from University Cork College in Ireland, and colleagues randomly assigned 85 female patients with IBS to treatment with B. infantis 35624 for 4 weeks and 80 to treatment with an inert placebo.

For patients with very frequent or very few bowel movements, the bacteria had a significant effect in normalizing the frequency, the investigators reported this week at the annual meeting of the American College of Gastroenterology in Honolulu.

This is "a unique finding," Quigley noted, since "the other agents used or tested in IBS have tended to have efficacy in either a diarrhea-predominant group or a constipation-predominant group, but not in both."

Changes in bowel frequency were accompanied by "very significant improvement in individual symptoms, such as pain and bloating," he added.

"If we continue to show true efficacy for probiotics," the researcher maintained, "this will represent a major step forward because they have the great advantage of having no safety issues to confront."



Reuters 2005. All Rights Reserved.

http://today.reuters.com/news/newsArticle.aspx?type=healthNews&storyID=2005-11-01T215012Z_01_WRI178541_RTRUKOC_0_US-PROBIOTIC-RELIEVES-IRRITABLE-BOWEL-SYNDRO.xml&archived=False

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HeatherAdministrator

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Loc: Seattle, WA
Pharmacological Basis for the Medicinal Use of Ginger in Gastrointestinal Disorders new
#232655 - 12/19/05 04:50 PM

Pharmacological Basis for the Medicinal Use of Ginger in Gastrointestinal Disorders

Authors: Ghayur, Muhammad1; Gilani, Anwarul2

Source: Digestive Diseases and Sciences, Volume 50, Number 10, October 2005, pp. 1889-1897(9)

Publisher: Springer

Abstract:

Ginger (rhizome of Zingiber officinale) has been widely used for centuries in gastrointestinal disorders, particularly dyspepsia, but its precise mode of action has yet to be elucidated.

This study was undertaken to study the prokinetic action of ginger and its possible mechanism of action. Prokinetic activity of ginger extract (Zo.Cr) was confirmed in an in vivo test when it enhanced the intestinal travel of charcoal meal in mice. This propulsive effect of the extract, similar to that of carbachol, was blocked in atropine-pretreated mice, a standard cholinergic antagonist. Likewise, Zo.Cr showed an atropine-sensitive dose-dependent spasmogenic effect in vitro as well as in isolated rat and mouse stomach fundus tissues.

In atropinized tissue, it showed spasmolytic activity as shown by the inhibition of 5-HT- and K+-induced contractions. A spasmolytic effect was also observed in other gut preparations either as noncompetitive inhibition of agonist doseresponse curves, inhibition of high K+(80 mM)-induced contractions, or displacement of Ca2+ doseresponse curves to the right, indicating a calcium antagonist effect.

Phytochemical analysis revealed the presence of saponins, flavonoids, and alkaloids in the crude extract. These data indicate that Zo.Cr contains a cholinergic, spasmogenic component evident in stomach fundus preparations which provides a sound mechanistic insight for the prokinetic action of ginger.

In addition, the presence of a spasmolytic constituent(s) of the calcium antagonist type may explain its use in hyperactive states of gut like colic and diarrhea.
Keywords: Zingiber officinale; ginger; prokinetic; cholinergic; calcium antagonist

Document Type: Research article

DOI: 10.1007/s10620-005-2957-2

Affiliations: 1: Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800, Pakistan, 2: Department of Biological and Biomedical Sciences, The Aga Khan University Medical College, Karachi, 74800, Pakistan,



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Peppermint possesses antispasmodic properties new
#233089 - 12/21/05 11:16 AM

American Family Physician

Treatment of Irritable Bowel Syndrome

SUSAN K. HADLEY, M.D., Middlesex Hospital, Middletown, Connecticut

STEPHEN M. GAARDER, PH.D., Applied Research Group, Middletown, Connecticut



Given the absence of a cure and the adverse effects of medications, patients with IBS often turn to complementary therapies. Peppermint possesses antispasmodic properties and has long been associated with improvement of digestive function. Peppermint leaves contain oils that have mild anesthetic properties, relieve nausea, and relax smooth muscle spasticity caused by histamine and cholinergic stimulation. A systematic review identified five trials that showed that peppermint oil relieved IBS symptoms. Three of these trials showed statistically significant benefit of peppermint over placebo (P < .001). The placebo response ranged from 13 to 52 percent with a mean of 31 percent including all five trials. A randomized double-blind placebo-controlled study28 of enteric-coated peppermint oil involving 110 patients showed 79 percent with less pain, 83 percent with decreased stool frequency, and 79 percent with less flatulence. Peppermint is contraindicated in patients with gastroesophageal reflux disease.


http://www.aafp.org/afp/20051215/2501.html

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