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Liu T, Asif IM, Bai C, Huang Y, Li B, Wang L. The effectiveness and safety of natural food and food-derived extract supplements for treating functional gastrointestinal disorders-current perspectives. Nutr Rev 2024:nuae047. [PMID: 38908001 DOI: 10.1093/nutrit/nuae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Functional gastrointestinal disorders (FGIDs) were highly prevalent and involve gastrointestinal discomfort characterized by non-organic abnormalities in the morphology and physiology of the gastrointestinal tract. According to the Rome IV criteria, irritable bowel syndrome and functional dyspepsia are the most common FGIDs. Complementary and alternative medicines are employed by increasing numbers of individuals around the world, and they include herbal and dietary supplements, acupuncture, and hypnosis. Of these, herbal and dietary supplements seem to have the greatest potential for relieving FGIDs, through multiple modes of action. However, despite the extensive application of natural extracts in alternative treatments for FGIDs, the safety and effectiveness of food and orally ingested food-derived extracts remain uncertain. Many randomized controlled trials have provided compelling evidence supporting their potential, as detailed in this review. The consumption of certain foods (eg, kiwifruit, mentha, ginger, etc) and food ingredients may contribute to the alleviation of symptoms associated with FGID,. However, it is crucial to emphasize that the short-term consumption of these components may not yield satisfactory efficacy. Physicians are advised to share both the benefits and potential risks of these alternative therapies with patients. Furthermore, larger randomized clinical trials with appropriate comparators are imperative.
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Affiliation(s)
- Tianxu Liu
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
| | - Ismail Muhammad Asif
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
| | - Chengmei Bai
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
| | - Yutian Huang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
| | - Bin Li
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
| | - Ling Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, Hubei 430070, China
- Key Laboratory of Environment Correlative Dietology (Huazhong Agricultural University), Ministry of Education, Wuhan, Hubei 430070, China
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Azimi M, Shahrbabaki HKD, Raeiszadeh M, Eslami O. Effects of a traditional herbal formula containing Melissa officinalis, Pimpinella anisum, and Rosa damascena on anxiety and depression in patients with constipation-predominant irritable bowel syndrome (IBS-C): A double-blind randomized clinical trial. Explore (NY) 2024; 20:103013. [PMID: 38937193 DOI: 10.1016/j.explore.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is associated with a high prevalence of anxiety and depression. This study aimed to evaluate the effects of a traditional Persian herbal formula containing Melissa officinalis, Pimpinella anisum, and Rosa damascena (MPR) on anxiety and depression in IBS patients with symptoms of constipation-predominant IBS (IBS-C). METHODS This double-blind randomized clinical trial was conducted in Afzalipour Hospital via block randomization method. A total of 96 IBS-C patients (based on Rome IV criteria), aged 18-60 years, were included in this study. Participants received capsules containing either 500 mg of herbal formula or placebo (cornstarch) twice a day for four weeks Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. RESULTS Forty-three patients in the intervention group and 45 patients in the control group completed this study. Except for the education level, there were no significant differences in the demographic characteristics between the two groups (P > 0.05). The mean levels of anxiety and depression, and total IBS symptom severity score showed no significant differences between the two groups at baseline (P > 0.05). After four weeks of treatment, the anxiety score considerably improvement in the treatment group (Cohen's d = -1.19, 95 % confidence intervals [CIs] -4.49 to 2.13), as did the depression score (Cohen's d = -1.93, 95 % CIs -4.32 to 2.79). CONCLUSION MPR considerably improved anxiety and depression in patients with IBS-C compared to the placebo without serious side effects.
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Affiliation(s)
- Maryam Azimi
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, PO Box: Haft-Bagh Highway, Kerman 7716913555, Iran.
| | - Hossein Karimi Dokht Shahrbabaki
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, PO Box: Haft-Bagh Highway, Kerman 7716913555, Iran
| | - Mahboobeh Raeiszadeh
- Herbal and traditional research center, Kerman University of Medical Sciences, PO Box: Haft-Bagh Highway, Kerman 7716913555, Iran
| | - Omid Eslami
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, PO Box: Haft-Bagh Highway, Kerman 7716913555, Iran.
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Mosaffa-Jahromi M, Molavi Vardanjani H, Fuzimoto A, Hunter J, Lankarani KB, Pasalar M. Efficacy and safety of aniseed powder for treating gastrointestinal symptoms of COVID-19: a randomized, placebo-controlled trial. Front Pharmacol 2024; 15:1331177. [PMID: 38292939 PMCID: PMC10824915 DOI: 10.3389/fphar.2024.1331177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Background: Gastrointestinal symptoms are prevalent amongst patients with a confirmed diagnosis of COVID-19 and may be associated with an increased risk of disease severity. This trial aimed to evaluate the efficacy and safety of aniseed (Pimpinella anisum L.) powder as an add-on therapy to standard care for treating gastrointestinal symptoms experienced by adults with an acute SARS-CoV-2 infection. Methods: The study was a randomized parallel-group double-blinded placebo-controlled add-on therapy trial. Adults with an acute SARS-CoV-2 infection who did not require hospitalization and reported at least one gastrointestinal symptom in the preceding 48 h were assigned to either the aniseed or placebo group in a 1:4 ratio. All 225 participants (45 in the aniseed group and 180 in the placebo group) were instructed to use 25 g of powdered aniseed or placebo twice daily for 2 weeks. The primary outcomes were the proportion of patients who experienced an improvement of at least one point in the symptom score after adjusting for age group, gender, and time. Backwards stepwise logistic regression was applied to calculate the risk ratios. The clinical symptoms and adverse events were assessed at the beginning, 1 week later, and at the end of the trial (week two). Results: Participants in the aniseed group were significantly more likely to report symptom improvement for abdominal pain [adjusted risk ratio (RR):0.55; 95% confidence interval (CI): 0.46-0.72], anorexia (RR:0.62; 95% CI: 0.47-0.82), and diarrhea (RR:0.19; 95% CI: 0.12-0.30), but not nausea/vomiting (RR:0.87; 95% CI: 0.71-1.08) or bloating (RR:0.87; 95% CI: 0.72-1.05). Two participants in the aniseed group and three participants in the placebo group reported mild to moderate adverse events. Conclusion: This study showed that 2 weeks of aniseed powder containing trans-anethole (87%-94%) may help improve abdominal pain, anorexia, and diarrhea in COVID-19 patients. The findings align with the known biological, multitargeted activity of P. anisum and trans-anethole, which includes inhibiting SARS-CoV-2 along with other anti-infective, anti-inflammatory, antioxidant, hepatoprotective, and anti-dysbiosis properties. Multicenter trials with larger sample sizes and longer follow-up are warranted to confirm these findings. Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT20120506009651N3).
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Affiliation(s)
- Maryam Mosaffa-Jahromi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Kazemi A, Iraji A, Esmaealzadeh N, Salehi M, Hashempur MH. Peppermint and menthol: a review on their biochemistry, pharmacological activities, clinical applications, and safety considerations. Crit Rev Food Sci Nutr 2024:1-26. [PMID: 38168664 DOI: 10.1080/10408398.2023.2296991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
In this manuscript, we conducted a comprehensive review of the diverse effects of peppermint on human health and explored the potential underlying mechanisms. Peppermint contains three main groups of phytochemical constituents, including essential oils (mainly menthol), flavonoids (such as hesperidin, eriodictyol, naringenin, quercetin, myricetin, and kaempferol), and nonflavonoid phenolcarboxylic acids. Peppermint exhibits antimicrobial, antioxidant, anti-inflammatory, immunomodulatory, anti-cancer, anti-aging, and analgesic properties and may be effective in treating various disorders, including gastrointestinal disorders (e.g., irritable bowel syndrome, dyspepsia, constipation, functional gastrointestinal disorders, nausea/vomiting, and gallbladder stones). In addition, peppermint has therapeutic benefits for psychological and cognitive health, dental health, urinary retention, skin and wound healing, as well as anti-depressant and anti-anxiety effects, and it may improve memory. However, peppermint has paradoxical effects on sleep quality and alertness, as it has been shown to improve sleep quality in patients with fatigue and anxiety, while also increasing alertness under conditions of monotonous work and relaxation. We also discuss its protective effects against toxic agents at recommended doses, as well as its safety and potential toxicity. Overall, this review provides the latest findings and insights into the properties and clinical effects of peppermint/menthol and highlights its potential as a natural therapeutic agent for various health conditions.
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Affiliation(s)
- Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Iraji
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niusha Esmaealzadeh
- Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Salehi
- Traditional and Complementary Medicine Research Center (TCMRC), Department of Traditional Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Elmaghraby DA, Alsalman GA, Alawadh LH, Al-Abdulqader SA, Alaithan MM, Alnuwaysir BI. Integrated traditional herbal medicine in the treatment of gastrointestinal disorder: the pattern of use and the knowledge of safety among the Eastern Region Saudi population. BMC Complement Med Ther 2023; 23:373. [PMID: 37872543 PMCID: PMC10591345 DOI: 10.1186/s12906-023-04197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Herbal medicine is commonly integrated with conventional medicine in Saudi Arabia, especially for the management of digestive disorders. However, the majority of Saudis use herbal remedies without prior consultation with a physician, which raises concerns about their appropriate and safe use. The aim of this study was to assess the level of awareness among the Saudi population regarding the proper utilization and potential adverse effects of frequently used herbs for the treatment of gastrointestinal (GI) diseases. METHODS A cross-sectional survey was conducted in Saudi Arabia from January to March 2021. An electronic self-administered questionnaire was distributed. RESULTS A total of 543 participants from different age groups, educational levels, and cities across Saudi Arabia completed the study questionnaire. The most commonly used herbs at home by the participants were: myrrh, parsley, black seed, chamomile, mint, anise, clove, and green tea. 57.7% of the participants perceived herbs as safer than conventional medicines; 27.3% reported that using herbal remedies over conventional medicine was a family tradition, and 21.4% used herbs because they were cheaper than conventional medicines. CONCLUSION Herbal remedies, including myrrh, parsley, blackseed, chamomile, mint, and anise, are commonly employed for the treatment of gastrointestinal disorders in Saudi Arabia. However, the knowledge level of participants regarding potential side effects and drug-herb interactions was found to be deficient. As such, there is a pressing need for educational campaigns and community awareness programs to elucidate the proper usage of herbal remedies and to caution against their potential adverse effects.
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Affiliation(s)
- Dalia Ahmed Elmaghraby
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia.
| | - Ghufran Adnan Alsalman
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia
| | - Layla Hassan Alawadh
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia
| | - Sara Abdulaziz Al-Abdulqader
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia
| | - Malak Mohammed Alaithan
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia
| | - Bayan Ibrahim Alnuwaysir
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al Hofuf, 31982, Saudi Arabia
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Arafat M, Sakkal M, Bostanudin MF, Alhanbali OA, Yuvaraju P, Beiram R, Sadek B, Akour A, AbuRuz S. Enteric-coating film effect on the delayed drug release of pantoprazole gastro-resistant generic tablets. F1000Res 2023; 12:1325. [PMID: 38596002 PMCID: PMC11002526 DOI: 10.12688/f1000research.140607.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 04/11/2024] Open
Abstract
Background: Enteric coating films in acidic labile tablets protect the drug molecule from the acidic environment of the stomach. However, variations in the excipients used in the coating formulation may affect their ability to provide adequate protection. This study is the first to investigate the potential effects of coating materials on the protective functionality of enteric coating films for pantoprazole (PNZ) generic tablets after their recall from the market. Methods: A comparative analysis was conducted between generic and branded PNZ products, using pure drug powder for identification. The in vitro release of the drug was evaluated in different pH media. The study also utilized various analytical and thermal techniques, including differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), X-ray diffraction (XRD), scanning electron microscopy (SEM), Fourier-transform infrared (FTIR), and confocal Raman microscopy. Results: The in vitro assessment results revealed significant variations in the release profile for the generic product in acidic media at 120 min. DSC and TGA thermal profile analyses showed slight variation between the two products. XRD analysis exhibited a noticeable difference in peak intensity for the generic sample, while SEM revealed smaller particle sizes in the generic product. The obtained spectra profile for the generic product displayed significant variation in peaks and band intensity, possibly due to impurities. These findings suggest that the excipients used in the enteric coating film of the generic product may have affected its protective functionality, leading to premature drug release in acidic media. Additionally, the presence of polysorbate 80 (P-80) in the brand product might improve the properties of the enteric coating film due to its multi-functionality. Conclusions: In conclusion, the excipients used in the brand product demonstrated superior functionality in effectively protecting the drug molecule from acidic media through the enteric coating film, as compared to the generic version.
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Affiliation(s)
- Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, 64141, United Arab Emirates
| | - Molham Sakkal
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, 64141, United Arab Emirates
| | | | - Othman Abdulrahim Alhanbali
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestinian Territory
| | - Priya Yuvaraju
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates
| | - Rami Beiram
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates
| | - Bassem Sadek
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates
| | - Amal Akour
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates
| | - Salahdein AbuRuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Amman Governorate, 11942, Jordan
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Chiarioni G, Popa SL, Ismaiel A, Pop C, Dumitrascu DI, Brata VD, Duse TA, Incze V, Surdea-Blaga T. The Effect of Polyphenols, Minerals, Fibers, and Fruits on Irritable Bowel Syndrome: A Systematic Review. Nutrients 2023; 15:4070. [PMID: 37764853 PMCID: PMC10534596 DOI: 10.3390/nu15184070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. Various dietary factors have been implicated in the pathogenesis and management of IBS symptoms. This systematic review aims to evaluate the effects of polyphenols, minerals, fibers, and fruits on the symptoms and overall well-being of individuals with IBS. MATERIALS AND METHODS A comprehensive literature search was conducted in several electronic databases, including PubMed, Scopus, and Web of Science. Studies published up until July 2023 were included. RESULTS The selected studies varied in terms of study design, participant characteristics, intervention duration, and outcome measures. Overall, the findings suggest that dietary interventions involving polyphenols, minerals, fibers, and fruits can have a positive impact on IBS symptoms. Dietary fiber supplementation, particularly soluble fiber, has been associated with reduced bloating and enhanced stool consistency. CONCLUSIONS This systematic review provides evidence supporting the beneficial effects of polyphenols, minerals, fibers, and fruits in IBS patients. These dietary components hold promise as complementary approaches for managing IBS symptoms. However, due to the heterogeneity of the included studies and the limited number of high-quality randomized controlled trials, further well-designed trials are warranted to establish the optimal dosages, duration, and long-term effects of these interventions. Understanding the role of specific dietary components in IBS management may pave the way for personalized dietary recommendations and improve the quality of life for individuals suffering from this complex disorder.
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Affiliation(s)
- Giuseppe Chiarioni
- Division of Gastroenterology B, AOUI Verona, 37126 Verona, Italy;
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA
| | - Stefan Lucian Popa
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (A.I.); (T.S.-B.)
| | - Abdulrahman Ismaiel
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (A.I.); (T.S.-B.)
| | - Cristina Pop
- Department of Pharmacology, Physiology, and Pathophysiology, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Dinu Iuliu Dumitrascu
- Department of Anatomy, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Vlad Dumitru Brata
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (V.I.)
| | - Traian Adrian Duse
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (V.I.)
| | - Victor Incze
- Faculty of Medicine, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (V.D.B.); (T.A.D.); (V.I.)
| | - Teodora Surdea-Blaga
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania; (A.I.); (T.S.-B.)
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Matera R, Lucchi E, Valgimigli L. Plant Essential Oils as Healthy Functional Ingredients of Nutraceuticals and Diet Supplements: A Review. Molecules 2023; 28:molecules28020901. [PMID: 36677959 PMCID: PMC9862182 DOI: 10.3390/molecules28020901] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Essential oils (EOs) are mixtures of volatile molecules endowed with health-promoting biological activities that go beyond their role as aromas and natural preservatives and can be exploited to develop functional foods and diet supplements. Their composition is briefly addressed along with regulatory aspects. The potential health benefit of human diet supplementation with EOs is outlined through a review of the recent literature on available clinical trials and preclinical research concerning EOs activity towards: (1) irritable bowel syndrome; (2) inflammatory bowel disease; (3) regulation of microbiota; (4) gastroprotection; (5) hepatoprotection; (6) protection of the urinary tract and diuresis; (7) management of metabolic disorders including hyperglycemia and hyperlipidemia; (8) anti-inflammatory and pain control; (9) immunomodulation and protection from influenza; and (10) neuroprotection and modulation of mood and cognitive performance. The emerging potential in such activities of selected EOs is given focus, particularly green and black cumin, bergamot, orange, myrtle, peppermint, sage, eucalyptus, lavender, thyme, lemon balm, ginger, and garlic.
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Affiliation(s)
- Riccardo Matera
- BeC s.r.l., Research & Development, Via C. Monteverdi 49, 47122 Forlì, Italy
| | - Elena Lucchi
- BeC s.r.l., Research & Development, Via C. Monteverdi 49, 47122 Forlì, Italy
| | - Luca Valgimigli
- Department of Chemistry “Ciamician”, University of Bologna, Via S. Giacomo 11, 40126 Bologna, Italy
- Correspondence: ; Tel.: +30-051-2095683
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Li R, Chen F, He X, Feng Y, Pei Q, Wang D, Liu X, Liu J, Hou X, Bai T. Nocebo response intensity and influencing factors in the randomized clinical trials of irritable bowel syndrome: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1018713. [PMID: 36606047 PMCID: PMC9807875 DOI: 10.3389/fmed.2022.1018713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To estimate the magnitude of the nocebo response and explore its influencing factors in irritable bowel syndrome (IBS). Methods The PubMed, Embase, and Cochrane Library databases were searched up to March 2021. We performed a random effects meta-analysis of the proportion of adverse events (AEs) in placebo-treated patients with IBS who are involved in parallel-designed, randomized, placebo-controlled trials investigating pharmacological interventions and evaluated the effect of trial characteristics on the magnitude of the nocebo response rate. Results A total of 6,107 studies were identified from the databases. After evaluation, 53 met the eligibility criteria and were included. The overall pooled nocebo response rate was 32% (95% CI: 26-38%). The most commonly reported AEs were headache (9%), nasopharyngitis (7%), abdominal pain (4%), and nausea (4%). The nocebo response rate was low compared with that in the treatment group applying probiotics, antispasmodics, and Traditional Chinese medicine, but high compared with that in antibiotic treatment group. The nocebo rate in patients using diaries to record AEs was lower than the average, and was higher in patients recording through checkup. Discussion Patients with IBS have significant nocebo response intensity in clinical trials. Based on findings in this study, we recommend the researchers pay attention to the common AEs and carefully analyze the relation to the intervention.
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Gavish L, Korchia G, Cohen S, Maor Y. A real-world evaluation of an herbal treatment for infantile colic reported by 1218 parents in Israel. J Pediatr Nurs 2022; 69:e39-e44. [PMID: 36528454 DOI: 10.1016/j.pedn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Infantile colic (IC) or fussing and crying behavior of unknown cause, affects up to 20% of the infant population and is one of the major reasons for parents to seek medical advice. Therapeutic options are limited and the key component for IC management is parental support. Fennel-based herbal treatments were shown to significantly reduce crying time. The current study was designed to evaluate the parent perception of effectiveness of a fennel-based commercially-available herbal treatment for IC (BabyCalm, Hisunit Ltd., Israel) using a retrospective online survey. DESIGN AND METHODS This was a real-world observational, case-control retrospective study. Parents of babies with IC symptoms, who either used the herbal product for their baby or did not use any product were invited to participate in an online survey during August-December 2019. The primary outcome was the perceived level of treatment success and symptom improvement. RESULTS 1218 parents of IC babies (48% females, 90% up to 3 months of age, 58% exclusively breast-fed) responded to the survey of whom 771 used the treatment. Significantly fewer IC-related symptoms were reported by parents who used the product compared to those that did not. Parents perceived the treatment as successful in 65% of the cases, reporting meaningful improvements within 30 min for 69%-79% of the symptoms. CONCLUSIONS The majority of parents perceived the herbal treatment as effective in rapid symptom reduction suggesting that this may provide a satisfactory solution for IC in the community.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel; The Saul and Joyce Brandman Hub for Cardiovascular Research and the Department of Medical Neurobiology, Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
| | | | - Shlomo Cohen
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yehoshua Maor
- Phytor Lab for Drug Development, Hadassah Medical Center Hebrew University Biotechnology Park (JBP), Jerusalem, Israel
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Ingrosso MR, Ianiro G, Nee J, Lembo AJ, Moayyedi P, Black CJ, Ford AC. Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome. Aliment Pharmacol Ther 2022; 56:932-941. [PMID: 35942669 DOI: 10.1111/apt.17179] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction, with a complex pathophysiology. Antispasmodics are prescribed as first-line therapy because of their action on gut dysmotility. In this regard, peppermint oil also has antispasmodic properties. AIM To update our previous meta-analysis to assess efficacy and safety of peppermint oil, particularly as recent studies have cast doubt on its role in the treatment of IBS METHODS: We searched the medical literature up to 2nd April 2022 to identify randomised controlled trials (RCTs) of peppermint oil in IBS. Efficacy and safety were judged using dichotomous assessments of effect on global IBS symptoms or abdominal pain, and occurrence of any adverse event or of gastro-oesophageal reflux. Data were pooled using a random effects model, with efficacy and safety reported as pooled relative risks (RRs) with 95% confidence intervals (CIs). RESULTS We identified 10 eligible RCTs (1030 patients). Peppermint oil was more efficacious than placebo for global IBS symptoms (RR of not improving = 0.65; 95% CI 0.43-0.98, number needed to treat [NNT] = 4; 95% CI 2.5-71), and abdominal pain (RR of abdominal pain not improving = 0.76; 95% CI 0.62-0.93, NNT = 7; 95% CI 4-24). Adverse event rates were significantly higher with peppermint oil (RR of any adverse event = 1.57; 95% CI 1.04-2.37). CONCLUSIONS Peppermint oil was superior to placebo for the treatment of IBS, but adverse events were more frequent, and quality of evidence was very low. Adequately powered RCTs of peppermint oil as first-line treatment for IBS are needed.
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Affiliation(s)
- Maria Rosa Ingrosso
- Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Judy Nee
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony J Lembo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Paul Moayyedi
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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12
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Jamalizadeh H, Ahmadi B, Shariffar F, Ansari M, Setayesh M, Shahesmaeili A, Tajadini H. Clinical evaluation of the effect of Zataria multiflora Boiss and Trachyspermum copticum (L.) on the patients with irritable bowel syndrome. Explore (NY) 2021; 18:342-346. [PMID: 34969608 DOI: 10.1016/j.explore.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND AIM Irritable Bowel Syndrome (IBS) is the most common gastrointestinal dysfunction characterized by abdominal pain or discomfort, as well as changes in bowel movements and stool shape. Given the global trend towards the increased use of complementary and alternative medicine (CAM), the high prevalence of IBS, the lack of a standard treatment for all IBS subtypes, and patients' willingness to use CAM treatments, investigations into CAM treatments are needed. Accordingly, the present study aimed to investigate the effect of a mix of two herbal medicines (Zataria-Trachyspermum, ZT) on the clinical symptoms of patients with IBS. EXPERIMENTAL PROCEDURE The present study was performed on 3 groups including the positive control, experimental, and placebo groups. The sample size was calculated as 150 participants. Fifty patients were assigned to one of three parallel groups (ZT capsule, placebo, and mebeverine capsule) by block randomization. All three groups were treated for 4 weeks. The patients were monitored in the follow-up stage for 2 additional weeks. RESULTS After the fourth week of intervention, symptoms of pain, bloating, and reflux showed a significant decrease in the ZT group compared to the placebo and mebeverine groups (P <0.05). Moreover, the participants in the ZT group reported a significant decrease in fatigue compared to the other two groups (P <0.05). CONCLUSION This study confirmed the positive effect of ZT on IBS symptoms, especially pain, bloating, constipation, and bowel movements.
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Affiliation(s)
- Hossein Jamalizadeh
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Department of Persian Medicine, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Bijan Ahmadi
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Fariba Shariffar
- Herbal and Traditional Medicine Research Center, Department of Pharmacogenosy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ansari
- Herbal and Traditional Medicine Research Center, Department of Pharmacogenosy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Setayesh
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Department of Persian Medicine, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating center for HIV surveillance,Institute for Futures Studies in Health,Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Tajadini
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Department of Persian Medicine, School of Traditional Medicine, Kerman University of Medical Sciences, Kerman, Iran
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13
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Billings W, Mathur K, Craven HJ, Xu H, Shin A. Potential Benefit With Complementary and Alternative Medicine in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2021; 19:1538-1553.e14. [PMID: 32961342 PMCID: PMC8112831 DOI: 10.1016/j.cgh.2020.09.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with irritable bowel syndrome (IBS) may pursue complementary and alternative medicine (CAM). We conducted a comprehensive systematic review and meta-analysis examining efficacy of CAM vs. placebo or sham in adults with IBS. METHODS Publication databases were searched for randomized controlled trials of CAM therapies (herbal therapy, dietary supplements, mind-body based, body-based, and energy-healing) in adults with IBS. Data were extracted to obtain pooled estimates of mean improvement in abdominal pain (standardized mean difference [SMD]) and relative risk (RR) of overall response using random effects models. Sensitivity and subgroup analyses along with quality assessments were completed. RESULTS Among 2825 articles identified, 66 were included. Herbal therapy (SMD=0.47, 95% CI: 0.20 to 0.75, I2=82%) demonstrated significant benefit over placebo for abdominal pain (low confidence in estimates). Benefit with mind-body based therapy for abdominal pain was of borderline significance (SMD=0.29, 95% CI: -0.01 to 0.59, I2=78%). Herbal therapy (RR=1.57, 95% CI: 1.31 to 1.88, I2=77%), dietary supplements (RR=1.95, 95% CI: 1.02 to 3.73, I2=75%), and mind-body based therapy (RR=1.67, 95% CI: 1.13 to 2.49, I2=63%) showed benefit for overall response compared to placebo (low confidence in estimates). Body-based and energy healing therapies demonstrated no significant benefit over placebo or sham for abdominal pain or overall response. CONCLUSIONS CAM therapies such as herbal or dietary supplements and mind-body based approaches may be beneficial for abdominal pain and overall response in IBS. However, overall quality of evidence is low. Rigorous, high quality clinical trials are warranted to investigate CAM in IBS.
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Affiliation(s)
- Wade Billings
- Department of Medicine, Indiana University School of Medicine
| | - Karan Mathur
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hannah J. Craven
- Ruth Lilly Medical Library, Indiana University School of Medicine
| | - Huiping Xu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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14
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Zheng L, Lu W, Xiao Q, Lai Y, Fan H, Sun Y, Huang D, Wang Y, Li Z, Jiang Z, Liu X, Zhang L, Zuo D, Shou Z, Tang Q, Huang H, Yang Y, Tang Z, Xiao J. Assessing the post-treatment therapeutic effect of pinaverium in irritable bowel syndrome: a randomized controlled trial. Sci Rep 2021; 11:13894. [PMID: 34230526 PMCID: PMC8260803 DOI: 10.1038/s41598-021-92990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder significantly decreasing patients' lives of quality and placing huge economic burden on our society. Existing studies indicated that the therapeutic effects maintained for a period of time after the treatments were discontinued. It is clinically important to assess these post-treatment therapeutic effects (PTTE), which prevent IBS from relapsing. To assess the PTTE in pinaverium treatment and obtain high-quality evidence to justify the use of PTTE for long-term IBS management, we performed this controlled, double blind study on patients with IBS who were randomized to pinaverium 50 mg (n = 132) or placebo (n = 132), three times daily, for 4 weeks, and were followed up for 57 weeks after the treatments. The primary endpoints were abdominal pain and stool consistency. The secondary endpoints were pain frequency and stool frequency. The tertiary endpoints were global overall symptom and adverse events. Three days after pinaverium was discontinued, endpoints rebounded only 23.2-42.8% (P < 0.015 cf. placebo). The PTTE (P < 0.05 cf. placebo) lasted 9-17 weeks, which is similar to other antispasmodics with a 15-week treatment in striking contrast to ≥ 1 year PTTE in cognitive behavior therapy and < 1 week PTTE in serotonin antagonist treatment indicating that PTTE length markedly depends on the medication class used for the treatment and less depends on treatment length. After 17 weeks, the stage could be considered as an IBS natural history [no significant differences between pinaverium and placebo (all endpoints' P's > 0.05)], during which an average of 51.5-56.4% of patients (pool pinaverium and placebo data together) had IBS symptoms. These results provide clinical insights into efficient and cost-effective management of refractory IBS, and lend support to the IBS management that the selection of a therapy should consider both its effectiveness during treatment and its PTTE after the treatment.Trial registration number: NCT02330029 (16/08/2016).
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Affiliation(s)
- Liang Zheng
- grid.410745.30000 0004 1765 1045Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, 23 Nanhu Rd, Nanjing, 210017 China
| | - Weimin Lu
- grid.410745.30000 0004 1765 1045Department of Internal Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Rd., Nanjing, 210029 China
| | - Qi Xiao
- grid.4367.60000 0001 2355 7002The School of Medicine, Washington University, 660 S Euclid Ave., St. Louis, MO 63110 USA
| | - Yaoliang Lai
- grid.413259.80000 0004 0632 3337Department of Gastroenterology, Beijing Xuanwu Hospital of Chinese Medicine, 8 Wanming Rd., Beijing, 100050 China
| | - Heng Fan
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Yuling Sun
- grid.410745.30000 0004 1765 1045The State Key Laboratory Cultivation Base for TCM Quality and Efficacy, The School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, 210023 China
| | - Dawei Huang
- grid.413259.80000 0004 0632 3337Department of Gastroenterology, Beijing Xuanwu Hospital of Chinese Medicine, 8 Wanming Rd., Beijing, 100050 China
| | - Yuanyuan Wang
- grid.410745.30000 0004 1765 1045Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, 23 Nanhu Rd, Nanjing, 210017 China
| | - Zhen Li
- grid.410745.30000 0004 1765 1045Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, 23 Nanhu Rd, Nanjing, 210017 China
| | - Zhengyan Jiang
- grid.410745.30000 0004 1765 1045Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, 23 Nanhu Rd, Nanjing, 210017 China
| | - Xingxing Liu
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Lijuan Zhang
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Dongmei Zuo
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Zhexing Shou
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Qing Tang
- grid.33199.310000 0004 0368 7223Department of Integrated Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Liberty Rd., Wuhan, 430022 China
| | - Huisuo Huang
- The Macrohard Institute of Health, 231 North Ave., Battle Creek, MI 49017 USA
| | - Yongqiang Yang
- The Macrohard Institute of Health, 231 North Ave., Battle Creek, MI 49017 USA
| | - Zongxiang Tang
- grid.410745.30000 0004 1765 1045The State Key Laboratory Cultivation Base for TCM Quality and Efficacy, The School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, 210023 China
| | - Jun Xiao
- The Macrohard Institute of Health, 231 North Ave., Battle Creek, MI 49017 USA
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15
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Tafazoli V, Tavakoli A, Mosaffa-Jahromi M, Cooley K, Pasalar M. Approach of Persian medicine to health and disease. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Giang J, Lan X, Crichton M, Marx W, Marshall S. Efficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysis. Nutr Diet 2021; 79:76-93. [PMID: 33960587 PMCID: PMC9290971 DOI: 10.1111/1747-0080.12672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Aim Biophenol‐rich nutraceuticals may be an adjuvant treatment for Crohn's disease (CD), ulcerative colitis (UC), symptomatic uncomplicated diverticular disease (SUDD), and irritable bowel syndrome (IBS). This systematic review and meta‐analysis aimed to determine the efficacy and safety of biophenol‐rich nutraceutical supplementation on CD, UC, SUDD, and IBS on gastrointestinal symptoms (GIS), quality of life (QoL), inflammatory and oxidative stress biomarkers, and adverse events compared to usual care or placebo. Methods PubMed, Embase, CINAHL, and CENTRAL were searched for randomised controlled trials until 27 April 2020. Outcomes were GIS, inflammatory and oxidative stress markers, QoL, and adverse events. The Cochrane Risk of Bias tool and GRADE were used to appraise studies. Data were pooled using Revman. Results Twenty‐three trials in CD, UC, and IBS patients were included. Compared with placebo, biophenol‐rich nutraceuticals improved GIS (SMD: 0.43 [95%CI: 0.22, 0.63]; GRADE: very low) in UC, CD, and IBS participants. In UC and CD participants, biophenol‐rich nutraceuticals improved CRP by 1.6 mg/L [95%CI:0.08, 3.11; GRADE: low], malondialdehyde by 1 mmol/L [95%CI:0.55, 1.38; GRADE: low]; but only resveratrol improved QoL (SMD: −0.84 [95%CI: −1.24, −0.44; GRADE: high). Resveratrol (for UC and CD participants) and peppermint oil (for IBS participants) had greater certainty in the evidence for improving GIS and QoL (GRADE: moderate to high). There was no effect on adverse events (P > .05). Conclusions Biophenol‐rich nutraceuticals may be an effective and safe adjuvant treatment for the management of CD, UC, and IBS; with higher certainty of evidence for resveratrol for UC and CD and peppermint oil for IBS.
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Affiliation(s)
- Joanna Giang
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xiao Lan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Megan Crichton
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wolfgang Marx
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Department of Science, Nutrition Research Australia, Sydney, New South Wales, Australia
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17
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Yuan R, Zhang D, Yang J, Wu Z, Luo C, Han L, Yang F, Lin J, Yang M. Review of aromatherapy essential oils and their mechanism of action against migraines. JOURNAL OF ETHNOPHARMACOLOGY 2021; 265:113326. [PMID: 32877718 DOI: 10.1016/j.jep.2020.113326] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/23/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Migraines have become a major threat to human health, as they significantly affect human health and quality of life due to a high prevalence rate, attack rate and pain intensity. Aromatherapy, with its comfortable and pleasant natural characteristics and rapid and efficient characteristics, is widely favored by patients in the folk. Chinese folk also have the application history and related records of aromatic plants in the treatment of migraine. AIM OF THE STUDY This study was conducted to review the pathogenesis of migraine, the application of plant essential oils in the treatment of migraine, and further explore the material basis and mechanism of action of plant essential oils against migraine. MATERIALS AND METHODS Search the electronic literature of essential oils with anti-migraine effect in Google Scholar, PubMed and China National Knowledge Infrastructure, and further search the research situation of the monomer components of essential oils in migraine, inflammation, pain and other aspects. RESULTS studies show that there are 10 types of plant essential oils that could relieve migraine symptoms, and that 16 monomers may play a role in migraine treatment by effectively inhibiting neurogenic inflammation, hyperalgesia and balancing vasorelaxation. CONCLUSION Aromatic plant essential oils can relieve migraine effectively, these findings can be used as an important part of the development of anti-migraine drugs.
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Affiliation(s)
- Ruifang Yuan
- Pharmacy School, State Key Laboratory of Characteristic Chinese Medicine Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, PR China
| | - Dingkun Zhang
- Pharmacy School, State Key Laboratory of Characteristic Chinese Medicine Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, PR China
| | - Jinhui Yang
- Sichuan Baicao Jinggong Biotechnology Co., Ltd., Chengdu, 610000, PR China
| | - Zhenfeng Wu
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, PR China
| | - Chuanhong Luo
- Pharmacy School, State Key Laboratory of Characteristic Chinese Medicine Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, PR China
| | - Li Han
- Pharmacy School, State Key Laboratory of Characteristic Chinese Medicine Resources in Southwest China, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, PR China
| | - Fangli Yang
- Sinopharm Sichuan Orthopedic Tehnology & Equipment Co., Ltd., Chengdu, 610000, PR China
| | - Junzhi Lin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, PR China; School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, PR China.
| | - Ming Yang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, PR China.
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18
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Gendi R, Jahan N. Pharmacological and Non-pharmacological Treatments of Irritable Bowel Syndrome and Their Impact on the Quality of Life: A Literature Review. Cureus 2020; 12:e9324. [PMID: 32850202 PMCID: PMC7444854 DOI: 10.7759/cureus.9324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a non-organic gastrointestinal disorder that adversely affects the quality of life (QoL). The etiology of the disease is not fully understood, and appropriate treatment is still a matter of debate. Therefore, we feel that a review that describes the different treatment methods of treatment is needed to provide the correct clues. A comprehensive literature search was performed on PubMed, including randomized clinical trials and review articles. We carefully reviewed the different treatment options mentioned in the published research papers and compared their results to address the treatment options for IBS. The current literature review reveals that pharmacological treatments such as antidepressants, vitamin D, probiotics, and antispasmodic drugs and non-pharmacological treatments including cognitive-behavioral therapy (CBT), acupuncture, anise, and diet modification can help control the symptoms of IBS and improve the QoL of patients.
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Affiliation(s)
- Reham Gendi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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19
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Farahmand M, Khalili D, Ramezani Tehrani F, Amin G, Negarandeh R. Could Anise decrease the intensity of premenstrual syndrome symptoms in comparison to placebo? A double-blind randomized clinical trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:/j/jcim.ahead-of-print/jcim-2019-0077/jcim-2019-0077.xml. [PMID: 32692701 DOI: 10.1515/jcim-2019-0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022]
Abstract
Background Premenstrual syndrome (PMS) has a high prevalence among women of reproductive ages but despite its high prevalence, it has no determined and absolute treatment, so far. So, the aim of the present study was to compare the effect Pimpinella Anisum (Anise) with placebo on the intensity of the symptoms of PMS. Methods The present study was a randomized double-blind controlled clinical trial. College students who were suffering from PMS and had the inclusion criteria were selected and randomly assigned into two groups of intervention (Anise) and control (placebo). Participants in the intervention group, received 110 mg capsules of Anise three times day (a total dose of 330 mg per day); the control group received similar capsules with the same dosing that contained starch. Consumption of the capsules was started 7 days before the start of the menstruation and continued until 3 days after, which was a total of 10 days during two consecutive menstruation cycles. The intensity of the symptoms of premenstrual syndrome was measured using Premenstrual Symptoms Screening Tool (PSST). To compare the intensity of the symptoms between the two study groups, generalized estimating equation statistical method was used. Results Eventually, sixty-seven 18-35 year old college students who were suffering from premenstrual syndrome were enrolled in the study. Comparing the mean score of the intensity of the syndrome between the two groups after the first and the second menstruation cycles showed a decrease in the intervention group to 13.9 (p-value<0.001; 95% CI: 16.5,-11.4) and 9.8 (p-value<0.001; 95% CI: 12.4,-7.3), respectively. Conclusion Results of the study showed that, in general, Anise was effective in decreasing the symptoms of premenstrual syndrome in comparison to placebo.
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Affiliation(s)
- Maryam Farahmand
- Research Institute for Endocrine Sciences, Reproductive Endocrinology Research Center, Shahid Beheshti University of Medical Sciences Tehran, Iran (Islamic Republic of)
- Nursing and Midwifery Care Research Center, Tehran University of Medical sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Amin
- Department of Pharmacognosy, faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing & Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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20
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Masuy I, Pannemans J, Tack J. Irritable bowel syndrome: diagnosis and management. MINERVA GASTROENTERO 2020; 66:136-150. [DOI: 10.23736/s1121-421x.19.02640-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Potent In Vitro Activity of Citrus aurantium Essential Oil and Vitis vinifera Hydrolate Against Gut Yeast Isolates from Irritable Bowel Syndrome Patients-The Right Mix for Potential Therapeutic Use. Nutrients 2020; 12:nu12051329. [PMID: 32392768 PMCID: PMC7284808 DOI: 10.3390/nu12051329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Irritable bowel syndrome (IBS) is a functional disorder without any pathological alteration, in which the alterations of the Candida/Saccharomyces ratio of the gut microbiota, the balance of pro and anti-inflammatory cytokines and the brain-gut-microbiome axis are important for the development and progression of IBS. The aim of the study was to identify natural products, including essential oils or hydrolates, which were contextually harmless for the gut beneficial strains (e.g., Saccharomyces spp.) but inhibitory for the pathogenic ones (Candida spp.). Methods: The effectiveness of 6 essential oils and 2 hydrolates was evaluated using microbiological tests, carried out on 50 clinical isolates (Candida, Saccharomyces and Galattomyces species) and 9 probiotic strains (Saccharomyces cerevisiae, Lactobacillus species, Akkermansia muciniphila and Faecalibacterium prausnitzii) and immunological and antioxidant assays. Results: The study led to a mixture based on a 1/100 ratio of Citrus aurantium var. amara essential oil / Vitis vinifera cv Italia hydrolate able to contextually reduce, in a concentration-dependent manner, the ability of Candida species to form hyphal filaments and have an interesting immunomodulatory and anti-oxidant action. This mixture can potentially be useful in the IBS treatment promoting the restoration of the intestinal microbial and immunological balance.
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Tan N, Gwee KA, Tack J, Zhang M, Li Y, Chen M, Xiao Y. Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta-analysis. J Gastroenterol Hepatol 2020; 35:544-556. [PMID: 31674057 DOI: 10.1111/jgh.14905] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The efficacy of herbal medicines (HMs) for functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional constipation (FC) is controversial. A systematic review with meta-analysis was conducted to determine their effectiveness for FGIDs. METHODS We searched the following electronic databases till July 2019 with English language restriction: The Cochrane Library, EMBASE and PUBMED. Randomized double-blind controlled trials of HMs compared with placebo or conventional pharmacological drugs for adult FGIDs patients were included. RESULTS In total, 49 trials involving 7396 participants with FGIDs were included. The risk of bias was low in 9, unclear in 36, and high in 4 trials. More than 33 different herbal formulae were tested. HMs demonstrated statistically significant benefits for symptom improvement compared with placebo in 46 trials (RR = 1.67, 95% CI 1.48-1.88). When compared with conventional pharmacological therapy in 5 trials, HMs were found to be non-inferior (RR = 1.10, 95% CI 1.03-1.18). The number of trials with regards to FD, IBS and FC were 19, 23 and 7 respectively. Subgroup analysis found that HMs were better than placebo in alleviating symptoms for FD (RR = 1.50, 95% CI 1.32-1.69), IBS (RR = 1.62, 95% CI 1.32-1.97) and FC (RR = 3.83, 95% CI 2.26-6.50). HMs tended to have more patients with adverse events than placebo, but similar to conventional pharmacological drugs. CONCLUSIONS Our findings provide a positive signal for HMs as a potentially well-tolerated and effective treatment for FGIDs, deserving further examination in high-quality trials.
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Affiliation(s)
- Niandi Tan
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kok Ann Gwee
- Department of Medicine, National University of Singapore and Gleneagles Hospital, Singapore
| | - Jan Tack
- Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Belgium
| | - Mengyu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuwen Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yinglian Xiao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Eid AM, Jaradat N. Public Knowledge, Attitude, and Practice on Herbal Remedies Used During Pregnancy and Lactation in West Bank Palestine. Front Pharmacol 2020; 11:46. [PMID: 32116721 PMCID: PMC7034419 DOI: 10.3389/fphar.2020.00046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/14/2020] [Indexed: 12/23/2022] Open
Abstract
The use of herbal products by pregnant and lactating mothers without awareness of their harmful effects may expose both mother and fetus or infant to great dangers, such as abortion, premature delivery, uterine bleeding, and physical and mental retardation of the fetus. Thus, the aim of this study was to investigate the extent to which herbal product treatment is used and the reason for which such products are used and to ensure that these reasons are correct. An ethnopharmacological survey (cross-sectional observational design study) using a pre-piloted questionnaire was undertaken on herbal products used by pregnant and lactating women in the West Bank area of Palestine. A questionnaire was distributed to 350 pregnant and lactating women. The informed consent forms, ethics, and aims of the present study were reviewed and approved by the Institutional Review Board (IRB) at An-Najah National University. To identify the most important species used, the use value (UV) index was employed, while the SPSS program was used to analyze the data. Collected data revealed that 13 medicinal plants are utilized, while 12 plants are not used during pregnancy. Moreover, 15 plants are utilized and 9 plants are not used during lactation for treating and dealing with various problems. The most commonly used plants belonged to 14 families, including Lamiaceae, Apiaceae, Leguminosae, and Rubiaceae. The plants most used during pregnancy were sage (Salvia fruticosa), anise (Pimpinella anisum), and peppermint (Mentha × piperita). Castor (Ricinus communis) oil, ginger (Zingiber officinale), saffron (Crocus sativus), and senna (Senna alexandrina) mostly were not used by pregnant women. Moreover, cinnamon (Cinnamomum verum), anise (P. anisum), peppermint (M. piperita), and sage (S. fruticosa) were mostly used during lactation. Castor (R. communis) oil, ginger (Z. officinale), garlic (Allium sativum), and aloe (Aloe vera) mostly were not used during lactation. This study is of great importance in order to decrease the possibility of endangering the lives of fetuses and infants. A combined effort among researchers, scientists, lactating women, and pregnant women may help in changing wrong uses and thoughts about medicinal plants and help to improve the overall health of both mother and fetus.
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Affiliation(s)
- Ahmad M Eid
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nidal Jaradat
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Black CJ, Yuan Y, Selinger CP, Camilleri M, Quigley EMM, Moayyedi P, Ford AC. Efficacy of soluble fibre, antispasmodic drugs, and gut–brain neuromodulators in irritable bowel syndrome: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2020; 5:117-131. [DOI: 10.1016/s2468-1253(19)30324-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/29/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
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Weerts ZZRM, Masclee AAM, Witteman BJM, Clemens CHM, Winkens B, Brouwers JRBJ, Frijlink HW, Muris JWM, De Wit NJ, Essers BAB, Tack J, Snijkers JTW, Bours AMH, de Ruiter-van der Ploeg AS, Jonkers DMAE, Keszthelyi D. Efficacy and Safety of Peppermint Oil in a Randomized, Double-Blind Trial of Patients With Irritable Bowel Syndrome. Gastroenterology 2020; 158:123-136. [PMID: 31470006 DOI: 10.1053/j.gastro.2019.08.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Peppermint oil is frequently used to treat irritable bowel syndrome (IBS), despite a lack of evidence for efficacy from high-quality controlled trials. We studied the efficacy and safety of small-intestinal-release peppermint oil in patients with IBS and explored the effects of targeted ileocolonic-release peppermint oil. METHODS We performed a double-blind trial of 190 patients with IBS (according to Rome IV criteria) at 4 hospitals in The Netherlands from August 2016 through March 2018; 189 patients were included in the intent-to-treat analysis (mean age, 34.0 years; 77.8% female; 57.7% in primary care), and 178 completed the study. Patients were randomly assigned to groups given 182 mg small-intestinal-release peppermint oil, 182 mg ileocolonic-release peppermint oil, or placebo for 8 weeks. The primary endpoint was abdominal pain response, as defined by the US Food and Drug Administration: at least a 30% decrease in the weekly average of worst daily abdominal pain compared with baseline in at least 4 weeks. The co-primary endpoint was overall relief of IBS symptoms, as defined by the European Medicines Agency. Secondary endpoints included abdominal pain, discomfort, symptom severity, and adverse events. RESULTS Abdominal pain response did not differ significantly between the peppermint oil and placebo groups: 29 of 62 patients in the small-intestinal-release peppermint oil group had a response (46.8%, P = .170 vs placebo), 26 of 63 patients in the ileocolonic-release peppermint oil group had a response (41.3%, P = .385 vs placebo), and 22 of 64 patients in the placebo group had a response (34.4%). We did not find differences among the groups in overall relief (9.7%, P = .317 and 1.6%, P = .351 vs 4.7% for placebo). The small intestinal peppermint oil did, however, produce greater improvements than placebo in secondary outcomes of abdominal pain (P = .016), discomfort (P = .020), and IBS severity (P = .020). Adverse events, although mild, were more common in both peppermint oil groups (P < .005). CONCLUSIONS In a randomized trial of patients with IBS, we found that neither small-intestinal-release nor ileocolonic-release peppermint oil (8 weeks) produced statistically significant reductions in abdominal pain response or overall symptom relief, when using US Food and Drug Administration/European Medicines Agency recommended endpoints. The small-intestinal-release peppermint oil did, however, significantly reduce abdominal pain, discomfort, and IBS severity. These findings do not support further development of ileocolonic-release peppermint oil for treatment of IBS. Clinicaltrials.gov, Number: NCT02716285.
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Affiliation(s)
- Zsa Zsa R M Weerts
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Ad A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ben J M Witteman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Cees H M Clemens
- Department of Gastroenterology, Alrijne Zorggroep, Leiden, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacobus R B J Brouwers
- Unit of Pharmacotherapy, Epidemiology, and Economics, University of Groningen, Groningen Research Institute of Pharmacy, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niek J De Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brigitte A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, Leuven, Belgium
| | - Johanna T W Snijkers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andrea M H Bours
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Daisy M A E Jonkers
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Hawrelak JA, Wohlmuth H, Pattinson M, Myers SP, Goldenberg JZ, Harnett J, Cooley K, Van De Venter C, Reid R, Whitten DL. Western herbal medicines in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Complement Ther Med 2019; 48:102233. [PMID: 31987249 DOI: 10.1016/j.ctim.2019.102233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/19/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of Western herbal medicines in the treatment of irritable bowel syndrome (IBS). DESIGN A computer-based search of MEDLINE, EMBASE, CINAHL, AMED, GreenFILE, Health Source: Nursing/Academic Edition, and the Cochrane Library was conducted. A hand-search of the bibliographies of relevant papers and previous meta-analyses and reviews was also undertaken. Trials were included in the review if they were double-blind and placebo-controlled investigating the effects of Western herbal medicines on IBS-related symptoms or quality of life. There were no language restrictions. Eligibility assessment and data extraction were performed by two independent researchers. For herbal medicines where there was more than 1 trial of similar design, data were synthesised using relative risk of symptoms improving using the random effects model. RESULTS Thirty-three trials were identified that met all eligibility criteria. Seventeen of these evaluated peppermint essential oil, fifteen other Western herbal medicines, and one trial evaluated peppermint oil in one arm and aniseed essential oil in the other arm. Eighteen different herbal preparations were evaluated in these trials. Data suggests that a number of Western herbal medicines may provide relief of IBS symptoms. Meta-analyses suggest that peppermint essential oil is both efficacious and well-tolerated in the short-term management of IBS. Aloe vera and asafoetida also demonstrated efficacy in reducing global IBS symptoms in meta-analyses. The herbal formulas STW 5, STW 5-II and Carmint, along with Ferula assa-foetida, Pimpenella anisum oil, the combination of Curcumin and Foeniculum vulgare oil, and the blend of Schinopsis lorentzii, Aesculus hippocastanum, and peppermint essential oil also demonstrated efficacy in rigorously-designed clinical trials. CONCLUSION A number of Western herbal medicines show promise in the treatment of IBS. With the exception of peppermint essential oil, Aloe vera, and asafoetida, however, none of the positive trials have been replicated. This lack of replication limits the capacity to make definitive statements of efficacy for these herbal medicines.
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Affiliation(s)
- Jason A Hawrelak
- College of Health and Medicine, University of Tasmania, Hobart, Australia; Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia.
| | - Hans Wohlmuth
- Integria Healthcare, Gallans Rd, Ballina, Australia; National Institute of Complementary Medicine, Western Sydney University, Campbelltown, Australia; School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Australia
| | - Martina Pattinson
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Stephen P Myers
- NatMed-Research Unit, Division of Research, Southern Cross University, Lismore, Australia
| | - Joshua Z Goldenberg
- Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia; Helfgott Research Institute, Portland, OR, USA
| | - Joanna Harnett
- Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia; The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Sydney, Australia
| | - Kieran Cooley
- Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia; Canadian College of Naturopathic Medicine, Toronto, Canada; Pacific College of Oriental Medicine, San Diego, USA
| | - Claudine Van De Venter
- Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rebecca Reid
- Australian Research Centre for Complementary and Integrative Medicine, University of Technology Sydney, Sydney, Australia; Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Dawn L Whitten
- College of Health and Medicine, University of Tasmania, Hobart, Australia
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Treatment Satisfaction with Persian Medicine in Patients with Insomnia. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.86837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mosavat SH, Jaberi AR, Sobhani Z, Mosaffa-Jahromi M, Iraji A, Moayedfard A. Efficacy of Anise (Pimpinella anisum L.) oil for migraine headache: A pilot randomized placebo-controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2019; 236:155-160. [PMID: 30853645 DOI: 10.1016/j.jep.2019.01.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Seyed Hamdollah Mosavat has made substantial contributions in conception, designing, acquisition of data and preformed clinical trial., Amin Moayedfard and Abbas Rahimi Jaberi had contribution in designing and preformed clinical trial. Zahra Sobhani and Maryam Mosaffa-Jahromi designed and prepared drugs of study. Aida Iraji has made drug biochemical assay. Seyed Hamdollah Mosavat had contribution in designing and revised the manuscript critically for important intellectual content and had contribution in designing and analyzing of data. Seyed Hamdollah Mosavat, Amin Moayedfard and Abbas Rahimi Jaberi had contribution in conception and designing and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
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Affiliation(s)
- Seyed Hamdollah Mosavat
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi Jaberi
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Sobhani
- Quality Control Department, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Mosaffa-Jahromi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Iraji
- Central Research Laboratory, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Moayedfard
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol 2019; 2:6-29. [PMID: 31294724 PMCID: PMC6507291 DOI: 10.1093/jcag/gwy071] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS. METHODS A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient. RESULTS Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments. CONCLUSIONS Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.
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Affiliation(s)
- Paul Moayyedi
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | | | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lesley Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Kvern
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Louis Liu
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - William G Paterson
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sacha Sidani
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Vanner
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
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The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. Altern Ther Health Med 2019; 19:21. [PMID: 30654773 PMCID: PMC6337770 DOI: 10.1186/s12906-018-2409-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/13/2018] [Indexed: 12/31/2022]
Abstract
Background Peppermint oil (PO) has intrinsic properties that may benefit patients with irritable bowel syndrome (IBS) symptoms. The study objective was to determine the effect of peppermint oil in the treatment of the IBS. Methods We systematically searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), ClinicalTrials.gov, EMBASE (Ovid), and Web of Science for randomized controlled trials (RCTs) of PO for IBS. We appraised the eligible studies by the Cochrane risk of bias tool. We performed random-effects meta-analysis on primary outcomes including global improvement in IBS symptoms and abdominal pain. A PRISMA-compliant study protocol is registered in PROSPERO Register [2016, CRD42016050917]. Results Twelve randomized trials with 835 patients were included. For global symptom improvement, the risk ratio (RR) from seven RCTs for the effect of PO (n = 253) versus placebo (n = 254) on global symptoms was 2.39 [95% confidence interval (CI): 1.93, 2.97], I2 = 0%, z = 7.93 (p < 0.00001). Regarding abdominal pain, the RR from six RCTs for the effect of PO (n = 278) versus placebo (n = 278) was 1.78 [95% CI: 1.43, 2.20], I2 = 0%, z = 5.23 (p < 0.00001). Overall, there were no differences in the reported adverse effects: PO (32 events, 344 total, 9.3%) versus placebo (20 events, 327 total, 6.1%) for eight RCTs; RR 1.40 [95% CI: 0.87, 2.26] I2 = 0%, z = 1.39 (p = 0.16). The number needed to treat with PO to prevent one patient from having persistent symptoms was three for global symptoms and four for abdominal pain. Conclusions In the most comprehensive meta-analysis to date, PO was shown to be a safe and effective therapy for pain and global symptoms in adults with IBS. Electronic supplementary material The online version of this article (10.1186/s12906-018-2409-0) contains supplementary material, which is available to authorized users.
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Weerts ZZRM, Keszthelyi D, Vork L, Aendekerk NCP, Frijlink HW, Brouwers JRBJ, Neef C, Jonkers DMAE, Masclee AAM. A Novel Ileocolonic Release Peppermint Oil Capsule for Treatment of Irritable Bowel Syndrome: A Phase I Study in Healthy Volunteers. Adv Ther 2018; 35:1965-1978. [PMID: 30284674 DOI: 10.1007/s12325-018-0802-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Peppermint oil (PO) has been shown to reduce abdominal pain in patients with irritable bowel syndrome (IBS). PO is assumed to induce intestinal smooth muscle relaxation and desensitization of nociceptive nerve afferents. To increase colonic PO concentration, an ileocolonic release peppermint oil (IC-PO) capsule has been developed. The aim of this study was to compare pharmacokinetic parameters of the currently available small intestinal release PO (SI-PO) and the novel IC-PO. METHODS In this randomized, double-blind, crossover study, subjects received 182 mg of either SI-PO or IC-PO in a crossover design with a washout period of more than 14 days. Blood samples were collected to determine menthol glucuronide concentrations. RESULTS Eight healthy volunteers (50% female, median age 22) were included. The time to reach the maximum concentration (Tmax) of IC-PO was significantly longer compared to SI-PO with a median (IQR) of 360 (360-405) versus 180 (120-180) min. The lag time (Tlag) was significantly longer with a median (IQR) of 225 (204-284) for IC-PO compared to 37 (6-65) min for SI-PO. The areas under the menthol glucuronide plasma concentration-time curves were significantly smaller with a median (IQR) of 2331 μg h/L (2006-2510) for IC-PO compared to 2623 μg h/L (2471-2920) for SI-PO. No significant differences were found in peak concentrations and elimination half-lives. CONCLUSION IC-PO has a significantly delayed peak menthol glucuronide concentration and Tlag, both pointing to the release of PO in the more distal part of the intestine. This may enhance therapeutic efficacy as it results in increased exposure of colonic mucosal afferents to the PO. A randomized controlled trial investigating the efficacy of SI and IC-PO in IBS is currently ongoing. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02291445, EudraCT database 2014-004195-32.
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Affiliation(s)
- Zsa Zsa R M Weerts
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nic C P Aendekerk
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Jacobus R B J Brouwers
- Unit of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daisy M A E Jonkers
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology-Hepatology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Pietrzak A, Skrzydło-Radomańska B, Mulak A, Lipiński M, Małecka-Panas E, Reguła J, Rydzewska G. Guidelines on the management of irritable bowel syndrome: In memory of Professor Witold Bartnik. PRZEGLAD GASTROENTEROLOGICZNY 2018; 13:259-288. [PMID: 30581501 PMCID: PMC6300851 DOI: 10.5114/pg.2018.78343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
These guidelines constitute an update of the previous "Recommendations on the management of irritable bowel syndrome" issued in 2008. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2008, the aetiology, epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of irritable bowel syndrome (IBS). The English-language acronym for the syndrome (IBS) has become popular in medical and popular scientific language. It is also widely recognized by patients who identify with this diagnosis. Therefore, in the discussed guidelines, this is what we will use.
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Affiliation(s)
- Anna Pietrzak
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Lipiński
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Ewa Małecka-Panas
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | - Jarosław Reguła
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
- Department of the Prevention of Alimentary Tract Diseases, Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
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Ford AC, Moayyedi P, Chey WD, Harris LA, Lacy BE, Saito YA, Quigley EMM. American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome. Am J Gastroenterol 2018; 113:1-18. [PMID: 29950604 DOI: 10.1038/s41395-018-0084-x] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Paul Moayyedi
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - William D Chey
- Division of Gastroenterology, Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA.
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Solvent-solvent fractionations of Combretum erythrophyllum (Burch.) leave extract: Studies of their antibacterial, antifungal, antioxidant and cytotoxicity potentials. ASIAN PAC J TROP MED 2017; 10:670-679. [PMID: 28870343 DOI: 10.1016/j.apjtm.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/16/2017] [Accepted: 06/17/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the biological activities of Combretum erythrophyllum (C. erythrophyllum) leaf extracts against infectious diseases' pathogenesis and their cytotoxicity potentials. METHODS Powdered leaf material (300 g) of C. erythrophyllum was extracted (1:10 w/v) using acetone to obtain the crude extract. Liquid-liquid fractionation was performed on the crude acetone extract (30 g) using solvents of different polarity. The bioautographic method was used to detect the inhibition of bacterial and fungal growth by active compounds present in the crude and fractions. The extracts were then tested on bacterial strains: Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa; fungal strains: Candida albicans (C. albicans), Cryptococcus neoformans, and Aspergillus fumigatus, by microtitre dilution method for MIC determination. RESULTS The extracts MIC values ranged between 0.08 and 2.50 mg/mL against the tested pathogens. Water fraction had the highest activity against bacteria strains, while the fungal assay revealed crude acetone extract and ethyl acetate fraction to be active against C. albicans (1.25 mg/mL), dichloromethane extract against C. albicans and A. fumigatus (0.16 mg/mL). Extract fractions showed a good antioxidant activity via DPPH, ABTS and hydroxyl radical scavenging assays, in the order: ethyl acetate > water > acetone > dichloromethane > hexane. The toxicity level of crude extract and fractions evaluated in Vero monkey kidney cells ranged from 34 to 223 μg/mL, while doxorubicin (IC50 = 7.19 μg/mL) served as the positive control. CONCLUSIONS It can be concluded that the extracts of C. erythrophyllum are safe for medicinal use in folk medicine for treating infectious and stress related diseases.
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