Peppermint Oil for IBS

Irritable Bowel Syndrome (IBS) is one of the more common gastrointestinal disorders seen in clinical practice today. The prevalence of IBS is high: affecting approximately 10-20% of the general population. This disorder not only impacts the quality of life of those affected, but it also accounts for many missed work days and increased financial burden upon patients seeking conventional medical treatments that often do not work. Patients with this functional bowel disorder commonly experience non-specific gastrointestinal (GI) symptoms such as abdominal pain or cramping, change in stool consistency or frequency, and bloating.

Peppermint oil (PO) is one of the most extensively studied and widely used CAM treatments in IBS patients. PO has an antagonistic effect on calcium channels, helping relax GI smooth muscle. This effect helps relieve cramping and pain associated with IBS. Enteric-coated PO is usually recommended over other forms because it dissolves lower in the GI tract; this reduces the risk of esophageal reflux (PO may relax the lower esophageal sphincter). Many recent studies have shown the benefit of using PO in IBS. A clinical trial of 110 patients who had IBS (excluding patients with small bowel bacterial overgrowth, lactose intolerance, or celiac disease) was conducted. [PubMed] After patients took 4 capsules of enteric-coated PO (225 mg/capsule) daily for 4 weeks, symptoms improved in 75% of those taking peppermint oil (compared to 38% of those taking placebo). A similar study [PubMed] involving 110 patients tested the effects of PO in patients with IBS. Patients took 1 capsule of PO (187 mg) or placebo three to four times daily and 15-50 min before meals for 1 month. At the completion of study, 79% of patients in the PO group experienced a reduction in the severity of abdominal pain; 83% had less abdominal distention; 83% had reduced stool frequency; and 79% had less flatulence. Comparatively, 43% in the placebo group had reduced abdominal pain; 29% had reduced distention; 32% had reduced stool frequency; and 22% had less flatulence. Another important study [PubMed] looked at the use of enteric-coated PO in children with IBS that were between the ages of 8 and 17. In this randomized, double-blind controlled trial 43 children with IBS were given 2 PO (0.1 – 0.2 mL) or placebo capsules t.i.d. for two weeks. At the conclusion of the trial 75% of the patients receiving PO reported a significant reduction in the severity of pain associated with IBS (compared with 19% receiving placebo).

Based on this latest research, PO should be considered in IBS patients because it is safe, effective, and cost-effective in treating global symptoms and pain due to its spasmolytic and anti-flatulent effect. It is suggested that a dose of 500 to 900 mg of PO be administered per day; however, this may depend on the severity of symptoms. Enteric-coated PO is usually recommended over other forms because it dissolves lower in the GI tract reducing the occurrence of esophageal reflux.

Studies of interest:

* Irritable bowel syndrome – The role of complementary medicines in treatment. Aust Fam Physician. 2009 Dec;38(12):966-8.
* The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. 2010 May;55(5):1385-90. Epub 2009 Jun 9.
* Review: fibre, antispasmodics, and peppermint oil are all effective for irritable bowel syndrome. Evid Based Med. 2009 Jun;14(3):84.

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Saccharomyces boulardii improves the eradication rate of Helicobacter pylori.

Helicobacter pylori is a growing infectious disease with a prevalence rate of 70-90% in developing countries and 25-50% in industrialized countries. Typical eradication therapy consists of one PPI along with two antibiotics; most commonly omeprazole is used along with amoxicillin and clarithromycin. While this therapy is effective in some, reports show this triple therapy is not as effective as it once was. In 2003, the eradication rate using triple therapy was reported to be 75%, while in 1995 it was 85%. Besides leaving 25% of the population with an active infection, triple therapy can be very difficult for patients to tolerate the side effects of the drugs. Many patients complain of diarrhea, upset stomach, and nausea while taking triple therapy.

A study out this month in the journal Helicobacter, examines the effects of adding Saccharomyces boulardii to typical triple therapy for the eradication of H.pylori. 991 patients with an active H.pylori infection who had not previously been treated for the infection before, were included in the study. Patients were randomized into three groups; group A received triple therapy only (20 mg omeprazole, 1000 mg amoxicillin, and 500 mg clarithromycin twice a day for 7 days) and group B received the triple therapy for seven days along with 250 mg (five billion CFU) three times a day of S.boulardii for four weeks, while group C received the triple therapy along with 250 mg (five billion CFU) three times a day of S.boulardii along with a mucoprotective agent, DA-9601an extract from Artemisia asiatica, for four weeks. At the end of the study, the results showed those in group A had an eradication rate of 71.6%, while in group B the rate was 80% and in group C it was 82.1%. Patients in group B and C reported they had less diarrhea than those in group A (3.3%, 3%, and 6% respectively). Patients in group A also reported more general side effects (taste disturbance, nausea, epigastric pain) than those in group B and C.

This study shows that supplementation with S.boulardii can be an effective adjunct to triple therapy for H.pylori infections. S.boulardii is well tolerated and resists the kill of antibiotics better than other strains of probiotics like Lactobacillus and Bifidobacterium. Besides increasing the rate of eradication, S.boulardii lowered the rate of some side effects including diarrhea. While more studies are needed to learn the exact mechanism of how S.boulardii acts specifically on H.pylori, we know it has immunomodulating and anti-inflammatory properties that may be playing a role.

For a comprehensive review on S.boulardii, please see the Point Institute’s Paper titled “Saccharomyces boulardii in Gastrointestinal Related Disorders.”

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Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome

Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: On reading Dr Lin’s discussion of the hypothesis of small intestinal bacterial overgrowth (SIBO) as a framework for understanding irritable bowel syndrome (IBS),1 I have concerns that the only data put forward are at best indirect, and that alternate conclusions could be drawn from the given findings.

Our report of whole-body calorimeter measurement of 24-hour excretion of hydrogen and methane2 (reference 19 in the article) is referred to incorrectly. Higher hydrogen volumes and 4-fold greater maximal rates of excretion were observed in patients compared with controls, all of whom were eating the same “standard Western diet,” not following lactulose ingestion as was stated. Patients and controls were provided identical food for 14 days prior to measurement, with 3-day rotation of fixed diet. The second reported study from the same group3 (reference 21 in the article) used the same methodology, which is also misstated. Whole-body excretion of hydrogen . . . [Full Text of this Article]