Herbs and Spices in the Treatment of Functional Gastrointestinal Disorders: A Review of Clinical Trials

Effects of Pistacia genus on gastrointestinal tract disorders: A systematic and comprehensive review

Gastrointestinal (GI) disorders characterized by persistent and recurrence gastrointestinal symptoms are prevalent. The genus Pistacia is widely emphasized as the relief of gastrointestinal diseases in traditional medicine. This review aimed to investigate the latest evidence on the effect of the Pistacia genus on GI tract disorders. The systematic search was performed following to PRISMA guidelines. The databases PubMed and Scopus were searched from 1980 to 2022 with restrictions to the original studies. Electronic databases were searched in title/abstract, using the keywords relevant to GI tract disorders. Forty-eight studies were included in this review following the inclusion criteria. Fifteen and 22 studies were clinical and animal studies, respectively, of which 6 clinical and 13 animal studies were on Inflammatory Bowel diseases. Seven clinical studies were on functional GI disorders. The most pieces of evidence from animal and clinical studies were on the intestinal inflammation and peptic ulcer affecting the inflammation as well as oxidative stress through different mechanistic pathways. The most referred active phytochemicals seem to be terpenoid compounds. Various in vitro studies have also shown the inhibitory activity of the different plant parts of Pistacia herbs on several GI tract cancer cells. Available scientific evidence supports the effects of various components of Pistacia genus plants in the field of GI tract diseases, especially digestive inflammations. Further studies are required to systematically evaluate the natural products of the genus Pistacia, particularly in the context of digestive disorders.

Evaluation of 90-day repeated dose oral toxicity of an aloe vera inner leaf gel beverage

Despite its popularity along with many proposed therapeutic applications, the safety profile of Aloe vera gel beverages remains unsettled. The putative toxicology concern has focused on the hydroxyanthraquinone derivatives (HADs) found in the latex portion of the Aloe leaf. Despite harvesting and processing designed to eliminate or significantly reduce these compounds, certain HADs, such as aloin, may be present and have been associated with carcinogenicity in non-decolorized whole leaf extract containing approximately 6400 ppm aloin A and 71 ppm aloin-emodin. Sprague Dawley rats had free access to drinking water or a commercially and widely available Aloe vera gel beverage (Forever Living Products) prepared from the inner leaves of Aloe barbadensis Miller containing 3.43 ppm total aloin for 90 days. Under the conditions of the study and based on the toxicological endpoints evaluated, there were no adverse test substance-related findings, including altered thyroid hormones. No histologic differences or histopathological changes were detected in the multiple tissues and organs examined. The Ki-67 proliferation assay demonstrated no increased cell proliferation in the liver, lungs, kidneys, or urinary bladder, which might have been attributed to the dietary administration of the Aloe vera gel beverage via drinking water for 90 days. These data lend increasing confidence regarding the safety of appropriately processed Aloe vera gel beverages, such as the beverage tested in this study.

Nutraceuticals and Pain Disorders of the Gut-Brain Interaction in Infants and Children: A Narrative Review and Practical Insights

Different nutraceuticals are often considered by parents of infants and children with abdominal pain and disorders of the gut-brain interaction. Herb extracts and natural compounds have long been used in traditional medicine, but clinical pediatric trials are very limited. This narrative review based on relevant studies identified through a search of the literature in Pubmed and Medline updated to October 2023 focused on the effect of nutraceuticals in infantile colic, functional abdominal pain, and irritable bowel syndrome in children and adolescents. Significant reductions in colic episodes and crying time were reported in two studies on fennel (seeds oil or tea), in three studies on different multiple herbal extracts (all including fennel), in one study on Mentha piperita, and in at least two double-blind randomized controlled studies on Lactobacillus reuteri DSM 17938 and Bifidobacterium lactis BB-12 (108 CFU/day for at least 21 days) in breast-fed infants. Compared to a placebo, in children with functional abdominal pain or irritable bowel syndrome, a significant reduction in pain was reported in two studies supplementing peppermint oil capsules or psyllium fibers, and in one study on corn fiber cookies, partial hydrolyzed guar gum, a specific multiple herbal extract (STW-5), or vitamin D supplementation. To date, there is moderate-certainty evidence with a weak grade of recommendation on Lactobacillus reuteri DSM 17938 (108 CFU/day) in reducing pain intensity in children with functional abdominal pain and for Lactobacillus rhamnosus GG (1-3 × 109 CFU twice daily) in reducing pain frequency and intensity in children with IBS. Further large and well-designed pediatric studies are needed to prove the efficacy and safety of different herbal extracts and prolonged use of studied products in infants and children with pain disorders of the gut-brain interaction.

Peppermint and menthol: a review on their biochemistry, pharmacological activities, clinical applications, and safety considerations

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.

The Use of Fibers, Herbal Medicines and Spices in Children with Irritable Bowel Syndrome: A Narrative Review

The pathophysiology of irritable bowel syndrome in children involves multiple factors. Thus, treatment options are variable, targeting both diet and the child's and parents' behavior via pharmacological and psychological interventions or neuromodulation. Parents are increasingly interested in complementary and alternative therapies for children with irritable bowel syndrome, especially when other treatments have been tried without relieving the child's symptoms. This paper examines current evidence for the benefits and side effects of herbal remedies and spices in pediatric patients with IBS. The benefits of peppermint oil, STW5, psyllium fiber, Curcuma, ginger, and other herbal medicines are discussed based on findings in the current literature.

The Effect of Ginger Supplementation on the Improvement of Dyspeptic Symptoms in Patients With Functional Dyspepsia

Background Functional dyspepsia (FD) is a common gastrointestinal disorder with a higher occurrence in the Western world. Conventional medications are not effective for FD with patients turning to alternative herbal medicines such as ginger. This study aimed to evaluate the effect of ginger supplementation on the improvement of FD symptoms. Methodology A before-and-after clinical study was conducted at the University of Debrecen, Internal Medicine outpatient department over a period of four weeks. Two Swanson ginger supplements each at a dose of 540 mg/day before lunch and dinner were given to 51 FD patients. Wilcoxon signed-rank test was used to estimate the differences in FD symptoms after ginger supplementation and at the baseline. The p-value was determined to test the association between variables, with p-values <0.05 considered the cutoff for statistically significant association. Results In this study, after four weeks of ginger supplementation, we observed a significant change in most dyspepsia symptoms as follows: postprandial fullness (p = 0.033, 95% CI = 0.01-0.26), early satiety (p = 0.001, 95% CI = 0.10-0.37), epigastric pain (p = 0.000, 95% CI = 0.16-0.42), epigastric burning (p = 0.003, 95% CI = 0.10-0.45), and heartburn (p = 0.209, 95% CI = -0.04-0.20). Conclusions Based on our findings ginger can be considered as a promising alternative supplementary medicine for FD.

Irritable Bowel Syndrome: Treating the Gut and Brain/Mind at the Same Time

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal (GI) disorders in the world. Although IBS does not affect a person's life span, it can significantly influence their quality of life. The treatment of IBS should be tailored to each patient's specific symptomatology because it can often be difficult to manage. Given that the pathogenesis of IBS is not well understood, it places a tremendous load on healthcare resources. Over the years, IBS has been described as either a simple GI disorder or a more complex multi-symptomatic gut-brain axis disorder. Many persons with IBS have psychological issues in addition to gastrointestinal symptoms, offering the door to non-pharmacological therapies such as cognitive behavioral therapy, gut-directed hypnosis, or psychodynamic interpersonal therapy. Non-pharmacological therapies with no side effects should be used as first-line therapy. Diet, exercise, microbiota-targeted therapies, and psychological treatments are among the most significant interventions. This review goes into the details of all the non-pharmacological interventions that can be used to treat IBS.

Beyond Seasoning-The Role of Herbs and Spices in Rheumatic Diseases

Although we have witnessed remarkable progress in understanding the biological mechanisms that lead to the development of rheumatic diseases (RDs), remission is still not achieved in a substantial proportion of patients with the available pharmacological treatment. As a consequence, patients are increasingly looking for complementary adjuvant therapies, including dietary interventions. Herbs and spices have a long historical use, across various cultures worldwide, for both culinary and medicinal purposes. The interest in herbs and spices, beyond their seasoning properties, has dramatically grown in many immune-mediated diseases, including in RDs. Increasing evidence highlights their richness in bioactive molecules, such as sulfur-containing compounds, tannins, alkaloids, phenolic diterpenes, and vitamins, as well as their antioxidant, anti-inflammatory, antitumorigenic, and anticarcinogenic properties. Cinnamon, garlic, ginger, turmeric, and saffron are the most popular spices used in RDs and will be explored throughout this manuscript. With this paper, we intend to provide an updated review of the mechanisms whereby herbs and spices may be of interest in RDs, including through gut microbiota modulation, as well as summarize human studies investigating their effects in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia.

The absence of genotoxicity of Aloe vera beverages: A review of the literature

Aloe has a long history of topical and systemic use with testimonials of countless health benefits and is one of the most popular botanical medicines in the world for the management of a wide variety both of benign and serious ailments including irritable bowel syndromes, osteoarthritis, Type II diabetes mellitus, and viral respiratory illness. The human consumption of Aloe vera extract in beverage form has substantially grown over the last several decades, in no small part, due to the increased consumer interest in alternative approaches to health benefits. The principal aim of the present paper is to characterize the research to date that has explored the genotoxic potential of Aloe vera inner leaf gel extract and decolorized whole leaf extract used in commercially available food-grade drinkable products which contain no more than 10 ppm aloin. Despite prevailing public health opinion, especially in Europe, the consensus of the reviewed studies retrieved from the peer-reviewed literature together with a mutagenic evaluation of an Aloe vera whole leaf decolorized spray-dried powder is that these products are not genotoxic.

Strategies for Producing Low FODMAPs Foodstuffs: Challenges and Perspectives

In recent years, there has been a growing interest in a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) as a promising therapeutic approach to reduce the symptoms associated with irritable bowel syndrome (IBS). Hence, the development of low FODMAPs products is an important challenge for the food industry, and among the various foodstuffs associated with the intake of FODMAPs, cereal-based products represent an issue. In fact, even if their content in FODMAPs is limited, their large use in diet can be an important factor in developing IBS symptoms. Several useful approaches have been developed to reduce the FODMAPs content in processed food products. Accurate ingredient selection, the use of enzymes or selected yeasts, and the use of fermentation steps carried out by specific lactic bacteria associated with the use of sourdough represent the technical approaches that have been investigated, alone or in combination, to reduce the FODMAPs content in cereal-based products. This review aims to give an overview of the technological and biotechnological strategies applicable to the formulation of low-FODMAPs products, specifically formulated for consumers affected by IBS. In particular, bread has been the foodstuff mainly investigated throughout the years, but information on other raw or processed products has also been reported. Furthermore, taking into account the required holistic approach for IBS symptoms management, in this review, the use of bioactive compounds that have a positive impact on reducing IBS symptoms as added ingredients in low-FODMAPs products is also discussed.

Mediterranean Diet: The Role of Phenolic Compounds from Aromatic Plant Foods

Today's global food system aggravates climate change while failing in meeting SDG2 and more. Yet, some sustainable food cultures, such as the Mediterranean Diet (MD), are simultaneously safe, healthy, and rooted in biodiversity. Their wide range of fruits, herbs, and vegetables convey many bioactive compounds, often associated with colour, texture, and aroma. Phenolic compounds are largely responsible for such features of MD's foods. These plant secondary metabolites all share in vitro bioactivities (e.g., antioxidants), and some are evidenced in vivo (e.g., plant sterols lower cholesterol levels in blood). The present work examines the role of polyphenols in the MD, with respect to human and planetary health. Since the commercial interest in polyphenols is increasing, a strategy for the sustainable exploitation of Mediterranean plants is essential in preserving species at risk while valuing local cultivars (e.g., through the geographical indication mechanism). Finally, the linkage of food habits with cultural landscapes, a cornerstone of the MD, should enable awareness-raising about seasonality, endemism, and other natural constraints to ensure the sustainable exploitation of Mediterranean plants.

Functional gastrointestinal disorders in Jordanian infants: a pilot study

Introduction

Functional gastrointestinal disorders (FGIDs) encompass a wide spectrum of disorders that may be diagnosed using the Rome criteria.

Aim

To identify the prevalence and risk factors for the development of FGIDs in Jordanian infants.

Material and methods

We conducted a cross-sectional study to investigate the prevalence of FGIDs among infants and characterise any possible risk factors. Between 1 January 2020, and 30 December 2020, patients who presented to the paediatric follow-up clinic at King Abdullah University Hospital were recruited. Parents were interviewed and asked to complete an Arabic version of the Rome IV diagnostic questionnaire for pediatric gastrointestinal disorders for neonates and toddlers. Data regarding the parents' gastrointestinal symptoms and children's medical history were collected. Children's electronic medical files were also reviewed.

Results

The study included 127 children, 78 (61%) were males. The median age was 40 days. According to the Rome IV criteria eighty-two (64%) of the infants fit the diagnosis for at least one disorder. The most prevalent disorder was functional constipation (n = 78, 95%) followed by infant dyschezia (n = 11, 13%). Compared to infants who did not meet the diagnostic criteria, herb intake and circumcision rates were significantly higher among those who did. Univariate analyses revealed that Infants with FGIDs were more likely to ingest herbs.

Conclusions

FGIDs were common among young infants. Functional constipation was the most commonly diagnosed FGID. Infants with with FGIDs were more likely to intake herbs to ease the symtpoms.

Current Understanding of the Molecular Basis of Spices for the Development of Potential Antimicrobial Medicine

Antimicrobial resistance increases day by day around the world. To overcome this situation new antimicrobial agents are needed. Spices such as clove, ginger, coriander, garlic, and turmeric have the potential to fight resistant microbes. Due to their therapeutic properties, medicinal herbs and spices have been utilized as herbal medicines since antiquity. They are important sources of organic antibacterial substances that are employed in treating infectious disorders caused by pathogens such as bacteria. The main focus of the study is the bioactivity of the active ingredients present in different kinds of naturally available spices. We conducted a thorough search of PubMed, Google Scholar, and Research Gate for this review. We have read many kinds of available literature, and in this paper, we conclude that many different kinds of naturally available spices perform some form of bioactivity. After reading several papers, we found that some spices have good antimicrobial and antifungal properties, which may help in controlling the emerging antimicrobial resistance and improving human health. Spices have many phytochemicals, which show good antimicrobial and antifungal effects. This review of the literature concludes that the natural bioactivate compounds present in spices can be used as a drug to overcome antimicrobial resistance in human beings.

Aqueous cinnamon extract ameliorates bowel dysfunction and enteric 5-HT synthesis in IBS rats

Cinnamon protects against irritable bowel syndrome with diarrhea (IBS-D) in humans, but its efficacy and underlying mechanism of action remain poorly understood. Maternally separated (MS) IBS-D rat model and 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced post-inflammatory IBS-D rat model are characterized by visceral hyperalgesia and diarrhea. This study used the two models to evaluate the effect of cinnamon extract (CE) on bowel symptoms. The MS rat model was also used to explore its underlying anti-IBS mechanism. cinnamon extract reduced defecation frequency and visceral hyperalgesia in MS rats in a dose-dependent manner and effectively improved visceral hyperalgesia in TNBS rats. The efficacy of cinnamon extract was comparable to the positive drug serotonin receptor 3 (5-HT3) selective antagonist, Ramosetron. Excessive 5-HT, a well-known pathogenic factor for IBS, in the colon and circulation of IBS rats was reduced after cinnamon extract intervention. Both, gene and protein levels of the colonic 5-HT synthetase, Tryptophan Hydroxylase 1 (Tph1), were also decreased in CE-treated IBS rats. In addition, a luciferase assay revealed that cinnamon extract and its major components, catechin, procyanidin B1/2, cinnamic acid, and cinnamyl alcohol, significantly inhibited Tph1 transcription activity in vitro. These findings illustrated that aqueous cinnamon extract partially attenuated bowel symptoms in IBS models by directly inhibiting Tph1 expression and controlling 5-HT synthesis. This provides a scientific viewpoint for the use of cinnamon as a folk medication to treat IBS.

Involvement of NO/cGMP Signaling Pathway, Ca2+ and K+ Channels on Spasmolytic Effect of Everlasting Flower Polyphenolic Extract (Helichrysum stoechas (L.) Moench)

Functional gastrointestinal diseases (FGID) are worldwide prevalent conditions. Pharmacological treatments can be ineffective, leading the population to turn to herbal or traditional remedies. Helichrysum stoechas (L.) Moench is a medicinal plant traditionally used in the Iberian Peninsula to treat digestive disorders, but its effects on gastrointestinal motility have not been scientifically demonstrated. The aim of this work was to evaluate the antispasmodic effect of a polyphenolic extract of H. stoechas (HSM), its mechanism of action and its antioxidant activity. Isometric myography studies were performed in rat ileum, and malondialdehyde (MDA) and 4-hydroxyalkenals (4-HDA) levels were measured in rat jejunum. HSM reduced the integrated mechanical activity of spontaneous contractions. In Ca²⁺-free medium, HSM reduced the concentration-response curve of CaCl₂ similarly to verapamil. Pre-incubation with the extract blocked the contraction induced by Bay K8644, KCl and carbachol. L-NAME, ODQ, Rp-8-Br-PET-cGMPS, KT-5823, apamin, TRAM-34 and charybdotoxin reduced the relaxant effect of the extract on spontaneous contractions. MDA+4-HDA levels in LPS-treated tissue were reduced by the extract, showing antioxidant activity. In conclusion, HSM showed antispasmodic activity through inhibition of Ca²⁺ influx, activation of the NO/PKG/cGMP pathway and opening of Ca²⁺-activated K⁺ channels. The results suggest that H. stoechas could help in the prevention or treatment of FGIDs.

Peppermint essential oil: its phytochemistry, biological activity, pharmacological effect and application

Mentha (also known as peppermint), a genus of plants in the taxonomic family Lamiaceae (mint family), is widely distributed throughout temperate regions of the world. Mentha contains various constituents that are classified as peppermint essential oil (PEO) and non-essential components. PEO, consisting mainly of menthol, menthone, neomenthol and iso-menthone, is a mixture of volatile metabolites with anti-inflammatory, antibacterial, antiviral, scolicidal, immunomodulatory, antitumor, neuroprotective, antifatigue and antioxidant activities. Mounting evidence indicates that PEO may pharmacologically protect gastrointestinal, liver, kidney, skin, respiratory, brain and nervous systems, and exert hypoglycemic and hypolipidemic effects. Clinically, PEO is used for gastrointestinal and dermatological diseases, postoperative adjuvant therapy and other fields. This review aims to address the advances in the extraction and isolation of PEO, its biological activities, pharmacological effects, toxicity and applications, with an emphasis on the efficacy of PEO on burn wounds and psoriasis, providing a comprehensive foundation for research, development and application of PEO in future.

Cannabis Use is Associated With Reduced 30-Day All-cause Readmission Among Hospitalized Patients With Irritable Bowel Syndrome: A Nationwide Analysis

BACKGROUND

Cannabinoid receptors are potential therapeutic targets in a variety of gastrointestinal tract disorders. The authors hypothesize that the use of cannabis use is associated with better control of symptoms associated with irritable bowel syndrome (IBS). This study aimed to examine the utilization of inpatient services by patients with IBS who did and did not report the use of cannabis.

METHODS

This is a retrospective cohort study that utilized the 2016 Nationwide Readmissions Database. Inclusion criteria included a principal diagnosis of IBS. The primary outcome was 30-day hospital readmission rates for IBS-specific causes. Secondary outcomes included the 30-day hospital readmission rates for all causes, resource utilization, and the 5 most common principal diagnoses and independent risk factors associated with readmission.

RESULTS

Of the 7163 patients with IBS identified in the National Readmission Database, 357 reported the use of cannabis. The 30-day IBS-specific readmission rates were 1.5% in patients who reported cannabis use and 1.1% in those who did not report cannabis use (P=0.53). Among the cannabis users, none of the variables evaluated served as a significant predictor of IBS-specific readmission; median income was a predictor for readmission among those who did not report cannabis use (odds ratio, 2.77; 95% confidence interval, 1.15-6.67; P=0.02). The 30-day readmission rates for all causes were 8.1% and 12.7% for patients who did and did not report cannabis use, respectively. After adjusting for confounders, the odds of 30-day readmission for all causes were lower among patients who reported cannabis use compared with those who did not (adjusted odds ratio, 0.53; 95% confidence interval, 0.28-0.99; P=0.04). The 5 most frequent diagnoses at readmission among patients who did not report cannabis use were enterocolitis because of Clostridioides difficile, IBS without diarrhea, sepsis, noninfective gastroenteritis and colitis, and acute kidney failure. By contrast, the 5 most frequent readmission diagnoses for cannabis users were cyclical vomiting, IBS with diarrhea, endometriosis, right upper quadrant abdominal pain, and nausea with vomiting. A discharge disposition of "against medical advice" was identified as an independent risk factor for 30-day hospital readmission for all causes among patients who reported cannabis use. By contrast, higher comorbidity scores and discharges with home health care were independent predictors of 30-day hospital readmission for all causes among patients who did not report cannabis use. Private insurance was an independent factor associated with lower rates of readmission for all causes among those who did not report cannabis use.

CONCLUSION

Our review of the National Readmission Database revealed no statistically significant differences in 30-day readmission rates for IBS-specific causes when comparing patients who reported cannabis use with those who did not. However, the authors found that cannabis use was associated with reduced 30-day hospital readmission rates for all causes.

Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review

Nutritional ingredients, including various fibers, herbs, and botanicals, have been historically used for various ailments. Their enduring appeal is predicated on the desire both for more natural approaches to health and to mitigate potential side effects of more mainstream treatments. Their use in individuals experiencing upper gastrointestinal (GI) complaints is of particular interest in the scientific space as well as the consumer market but requires review to better understand their potential effectiveness. The aim of this paper is to review the published scientific literature on nutritional ingredients for the management of upper GI complaints. We selected nutritional ingredients on the basis of mentions within the published literature and familiarity with recurrent components of consumer products currently marketed. A predefined literature search was conducted in Embase, Medline, Derwent drug file, ToXfile, and PubMed databases with specific nutritional ingredients and search terms related to upper GI health along with a manual search for each ingredient. Of our literature search, 16 human clinical studies including nine ingredients met our inclusion criteria and were assessed in this review. Products of interest within these studies subsumed the categories of botanicals, including fiber and combinations, and non-botanical extracts. Although there are a few ingredients with robust scientific evidence, such as ginger and a combination of peppermint and caraway oil, there are others, such as melatonin and marine alginate, with moderate evidence, and still others with limited scientific substantiation, such as galactomannan, fenugreek, and zinc-l-carnosine. Importantly, the paucity of high-quality data for the majority of the ingredients analyzed herein suggests ample opportunity for further study. In particular, trials with appropriate controls examining dose-response using standardized extracts and testing for specific benefits would yield precise and effective data to aid those with upper GI symptoms and conditions.

Efficacy and Safety of Shenqu Xiaoshi Oral Liquid Compared With Domperidone Syrup in Children With Functional Dyspepsia

Background: Treatment of functional dyspepsia (FD) in children is generally symptomatic and unsatisfactory. Traditional Chinese medicines, such as Shenqu Xiaoshi Oral Liquid (SXOL), have been recommended to alleviate dyspeptic symptoms. However, evidence of their safety and efficacy remains limited to date. AIM: To assess whether 2 weeks of therapy with SXOL was non-inferior to domperidone syrup in children with FD.

Methods: In this randomized, double-blind, double-simulated, non-inferiority, multi-center clinical trial, we recruited children (3–14 years) with FD according to the Rome IV criteria from 17 tertiary medical centers across China. Patients were randomly allocated (1:1) to receive SXOL or domperidone syrup for 2 weeks. We compared the participants’ clinical scores from both groups based on the severity and frequency of dyspepsia symptoms according to Rome IV criteria (0, 1, 2, and 4 weeks after randomization). The primary endpoint was the total response rate, which was defined as the proportion of patients with a decrease of 30% or more in the FD symptoms clinical score from baseline, at the end of the 2-weeks treatment. A non-inferiority margin of -10% was set. Secondary endpoints and adverse events were assessed. This trial is registered with www.Chictr.org.cn, number ChiCTR1900022654.

Results: Between February 2019 and March 2021, a total of 373 patients were assessed for eligibility, and 356 patients were enrolled and randomized. The clinical response rate at week two was similar for SXOL [118 (83.10%) of 142] and domperidone [128 (81.01%) of 158]; difference 2.09; 95% CI −6.74 to 10.71, thereby establishing non-inferiority. The total FD symptom scores were significantly improved in the two groups at 1-, 2-, and 4-weeks follow-up periods (p &lt; 0.005). The decrease in symptom score compared with the baseline were similar between these two groups. Over the total study period, 10 patients experienced at least one treatment-related adverse event [six (3.37%)] in the SXOL group, four [(2.25%) in the domperidone group], although no serious adverse event was noted.

Conclusion: Treatment with SXOL effectively improves dyspeptic symptoms and is well tolerated. In addition, it is not inferior to domperidone syrup and leads to sustained improvement in Chinese children with FD.

How to manage irritable bowel syndrome in children

AIM

This paper discusses the risk factors and management of paediatric irritable bowel syndrome (IBS), with a focus on the role of the gastrointestinal microbiome.

METHODS

English articles of interest published in PubMed and Google Scholar were searched using subject heading and keywords of interest.

RESULTS

Only few randomised controlled trials on the management of IBS in children have been published. The vast majority of these intervention trials target to change the composition of the gastrointestinal microbiome. Most studies are underpowered. Major heterogeneities in study designs such as differences in inclusion criteria, including patients with different pain-related functional gastrointestinal disorders and differences in primary outcomes, make it impossible to formulate recommendations. Overall, few adverse events are reported what could indicate safety or point to suboptimal conduction of clinical trials and safety reporting. However, it can also not be excluded that some interventions such as the administration of selected probiotic products may result in benefit.

CONCLUSION

There is insufficient evidence to recommend any therapeutic intervention in paediatric IBS, including manipulation of the gastrointestinal tract microbiome, despite the evidence that dysbiosis seems an associated pathophysiologic factor. More designed prospective trials are needed since IBS is not a rare condition during childhood.

Efficacy of herbal treatments for functional dyspepsia: A systematic review and meta-analysis of randomized clinical trials

Functional dyspepsia (FD) is a very common condition globally. Relevant keywords were searched for in title and abstract of selected databases, that is, Medline/PubMed, Scopus, Embase, Web of knowledge, and Google Scholar. Placebo and active-control trials on herbal remedies amongst adults who were diagnosed with FD were included. Dichotomous outcomes were presented as relative risk (RR) with 95% confidence interval (CI) and continuous outcomes were presented as pooled standardized mean difference (SMD) with 95% CI. Forty-nine randomized controlled trials (RCTs) were entered into meta-analysis (6,987 subjects). Herbal remedies resulted in a higher improvement in FD symptoms in comparison with the placebo (SMD = -0.58 [-0.66- -0.51], p < .00001 and RR = 1.73 [1.62-1.85], p < .00001). No significant difference between herbal remedies and placebo in the incidence of adverse events was observed (12.27 vs. 8.41%, RR = 1.06 [0.91-1.23], p = .45). Also, herbal remedies resulted in a higher improvement in quality of life in comparison with placebo (SMD = -0.64 [-0.73- -0.55], p < .00001). When comparing herbal remedies with conventional medicine through sensitivity analysis, no outcomes were significantly different (p > .05). Herbal remedies might be efficacious and safe in treating FD, and demonstrate comparable effect sizes for efficacy to conventional treatments. Further high-quality studies are warranted to firmly establish the clinical efficacy of the herbal remedies.

Upper Gastrointestinal Functional and Motility Disorders in Children

Children with disorders affecting the sensory and motor functions of the esophagus will present primarily with swallowing dysfunction, dysphagia, and chest pain, and those with disorders affecting the normal function of the stomach will present with symptoms like abdominal pain, nausea, and vomiting. Recent advances in the mechanisms of disease and technology have increased our understanding of gastrointestinal physiology and that knowledge has been applied to develop new diagnostic studies and therapeutic interventions. We present an overview of the clinical presentation, diagnosis, and treatment of common primary and secondary functional and motility disorders affecting the upper gastrointestinal tract in children.

Recent advances in nanocarriers for nutrient delivery

For the past few years, there has been a surge in the use of nutraceuticals. The global nutraceuticals market in 2020 was USD 417.66 billion, and the market value is expected to increase by 8.9% compound annual growth rate from 2020 to 2028. This is because nutraceuticals are used to treat and prevent various diseases such as cancer, skin disorders, gastrointestinal, ophthalmic, diabetes, obesity, and central nervous system-related diseases. Nutritious food provides the required amount of nutrition to the human body through diet, whereas most of the bioactive agents present in the nutrients are highly lipophilic, with low aqueous solubility leading to poor dissolution and oral bioavailability. Also, the nutraceuticals like curcumin, carotenoids, anthocyanins, omega-3 fatty acids, vitamins C, vitamin B12, and quercetin have limitations such as poor solubility, chemical instability, bitter taste, and an unpleasant odor. Additionally, the presence of gastrointestinal (GIT) membrane barriers, varied pH, and reaction with GIT enzymes cause the degradation of some of the nutraceuticals. Nanotechnology-based nutrient delivery systems can be used to improve oral bioavailability by increasing nutraceutical stability in foods and GIT, increasing nutraceutical solubility in intestinal fluids, and decreasing first-pass metabolism in the gut and liver. This article has compiled the properties and applications of various nanocarriers such as polymeric nanoparticles, micelles, liposomes, niosomes, solid lipid nanocarriers, nanostructured lipid carrier, microemulsion, nanoemulsion, dendrimers in organic nanoparticles, and nanocomposites for effective delivery of bioactive molecules.

The prevalence of irritable bowel syndrome among Saudi population in Riyadh by use of Rome IV criteria and self-reported dietary restriction

BACKGROUND

Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Diet may play a role in triggering the symptoms. We aimed to measure the prevalence of IBS and its types, and its association with food restrictions among the Saudi population, using the Rome IV criteria.

METHODS

A cross-sectional study was conducted in the outpatient clinics of three major hospitals in Riyadh in conjunction with an electronic survey which was shared on social media. A total of 1,319 subjects (706 males and 613 females) completed a questionnaire of four domains (sociodemography, Rome IV, food restriction, and herbs) between Nov 2019 and February 2020. Convenience sampling was used.

RESULTS

IBS was diagnosed in 104 subjects (7.9%) and, of these, 52% were IBS-M (mixed) type. The prevalence was higher in women than in men (4.9% vs. 3.0%; P = 0.006). A significant association was found between the presence of IBS symptoms and low income (P = 0.010), and not working (P < 0.0001). Most of the IBS patients showed food restriction related to milk (P < 0.0001) and legumes (P = 0.0029), besides other types of food and drinks.

CONCLUSIONS

IBS is less common among the Saudi population. A female gender, low family income, and working status, have the highest association with IBS. The foods most often restricted were legumes and milk. Future community studies may present an opportunity to relate with cultural differences and food preferences.

Complementary and Alternative Medicine Mind-Body Approaches Used Among Racially and Ethnically Diverse Adolescents

PURPOSE

The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach.

DESIGN AND METHODS

A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12-17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents.

RESULTS

While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM.

CONCLUSIONS

Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted.

PRACTICE IMPLICATIONS

Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.

Applicability of high-resolution NMR in combination with chemometrics for the compositional analysis and quality control of spices and plant-derived condiments

Over the last years, the consumption of spices and plant-derived condiments has increased considerably, owing to new culinary trends. Unfortunately, the current marketing channels make them highly vulnerable to adulteration and food fraud. High-resolution nuclear magnetic resonance (NMR) is a powerful tool for the compositional study of spices and plant-derived condiments. It allows the chemical characterization of a wide range of polar and non-polar metabolites, and provides unique structural information not available by other techniques. The chemometric-based analysis of NMR 'fingerprints' has been used to discriminate samples according to species and geographical origin and to detect adulterations, among other applications. The comprehensive identification and quantification of marker compounds can be achieved even in complex mixtures, demonstrating a great potential for high-throughtput quality control applications. © 2020 Society of Chemical Industry.

Complementary and Alternative Medicine Use in Pediatric Functional Abdominal Pain Disorders at a Large Academic Center

OBJECTIVE

To describe the use of complementary and alternative medicine (CAM) in pediatric functional abdominal pain disorders at a large Midwestern pediatric gastroenterology center.

STUDY DESIGN

A survey of patients attending a follow-up visit for functional abdominal pain disorders was completed. Data were collected on demographics, quality of life, use of conventional therapies, patient's opinions, and perception of provider's knowledge of CAM.

RESULTS

Of 100 respondents (mean age, 13.3 ± 3.5 years), 47 (60% female) had irritable bowel syndrome, 29 (83% female) had functional dyspepsia, 18 (67% female) had functional abdominal pain, and 6 (83% female) had abdominal migraine (Rome III criteria). Ninety-six percent reported using at least 1 CAM modality. Dietary changes were undertaken by 69%. Multivitamins and probiotics were the most common supplements used by 48% and 33% of respondents, respectively. One-quarter had seen a psychologist. Children with self-reported severe disease were more likely to use exercise (P < .05); those with active symptoms (P < .01) or in a high-income group (P < .05) were more likely to make dietary changes; and those without private insurance (P < .05), or who felt poorly informed regarding CAM (P < .05), were more likely to use vitamins and supplements. Seventy-seven percent of patients described their quality of life as very good or excellent.

CONCLUSIONS

The use of CAM in children with functional abdominal pain disorders is common, with a majority reporting a high quality of life. Our study underscores the importance of asking about CAM use and patient/family knowledge of these treatments.

Aloe vera and health outcomes: An umbrella review of systematic reviews and meta-analyses

This umbrella review aims to summarize the effects of Aloe vera on health outcomes and assess the strength of evidence. PubMed, Scopus, Embase, Cochrane database of systematic reviews, CINAHL, and AMED were searched from inception to October, 2019 for systematic reviews and meta-analyses of clinical trials that investigated the effects of Aloe vera on health outcomes. Two independent reviewers extracted data, assessed the methodological quality, and rated the credibility of evidence according to established criteria. Ten articles reporting 71 unique outcomes of Aloe vera were included. Of these, 47 (67%) were nominally statistically significant based on random-effects model (p ≤ .05). Only 3 outcomes were supported by highly suggestive evidence, whereas 42 outcomes were supported by weak evidence. The highly suggestive evidence supported benefits of Aloe vera in the prevention of second-degree infusion phlebitis (RR: 0.18, 95% CI: 0.10-0.32, p-value: 1.75 × 10^-9 ) and chemotherapy-induced phlebitis based on overall incidence (OR: 0.13, 95% CI: 0.08-0.20, p-value: 9.68 × 10^-20 ) and incidence of the second degree of severity (OR: 0.10, 95% CI: 0.07-0.14, p-value: 3.41 × 10^-35 ). However, the majority of the evidence were limited by small sample size and poor methodological quality. Therefore, despite the overall favorable effect of Aloe vera, more robust studies are needed.

Effectiveness of a nutraceutical supplement containing highly standardized perilla and ginger extracts in patients with functional dyspepsia

BACKGROUND

In Western countries functional dyspepsia (FD) has a prevalence of 10-20% among adults and although many drugs are currently available for use within clinical practice, FD remains an important challenge for physicians. Recently, food supplements that are ginger-based, along with other botanicals, have been proposed to be a possible natural alternative to pharmaceutical drugs to empirically counteract the symptoms of FD.

METHODS

We have therefore retrospectively analyzed the efficacy and safety profiles of a nutraceutical containing, in addition to a highly standardized ginger root extract, a multi-fractionated botanical obtained from Perilla frutescens leaf containing an innovative bouquet of compounds, including hydrophilic polyphenols and the lipophilic terpenoid perilla ketone.

RESULTS

The results of our single-group study, obtained from patients with a diagnosis of FD who were treated with the perilla/ginger nutraceutical, demonstrated a good efficacy profile, with a significant reduction observed in nearly all evaluated symptoms (epigastric pain, heartburn, gastric reflux, nausea, borborygmi, early satiety, diarrhea/constipation) starting from the first week of treatment that was further improved after 2 weeks. The treatment was well tolerated with very mild side effects (flatulence, meteorism, gastric burning, difficulty in falling asleep) lasting 3-4 days, which disappeared without stopping the treatment.

CONCLUSIONS

Despite all the limitations of our pragmatic study, we believe that the perilla and ginger supplement we have used can be considered a valid tool for an empirical approach to treating patients with FD, especially when a non-conventional drug treatment is preferable to the patient and considered suitable by the physician.

Complementary and Alternative Medicine for Functional Gastrointestinal Disorders

The relevance of functional gastrointestinal (GI) disorders and their impact on quality of life for many patients has become an increasingly important topic in gastroenterology. A gastroenterologist can expect to see 40% of patients for motility and functional GI disorders, thus highlighting the necessity for physicians to have a strong foundation of knowledge in treatment strategies for these patients with complex disorders. A significant number of patients who suffer with functional GI disorders turn to complementary and alternative therapies to maintain control over their symptoms and often are happy with therapeutic results. This narrative presents information and treatment algorithms for the gastroenterologist to better understand and use some of the most common complementary and alternative therapies for patients with functional dyspepsia, nausea and vomiting, and irritable bowel syndrome.

New advances in the treatment of paediatric functional abdominal pain disorders

This Review summarises recent pharmacological and upcoming alternative interventions for children with functional abdominal pain disorders (FAPDs). Pharmacological targets include prokinetics and drugs affecting gastric accommodation to treat postprandial distress and nausea. Similarly, anti-inflammatory agents, junctional protein regulators, analgesics, secretagogues, and serotonin antagonists have a therapeutic role for irritable bowel syndrome. Non-pharmacological treatments include peripheral electrical nerve field stimulation to the external ear, gastric electrical stimulation, dietary interventions such as low fructose and fibre based diets, and nutraceuticals, which include probiotics, prebiotics, and synbiotics. Newer psychological advances such as exposure-based cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness meditation are being investigated for paediatric functional pain. Lastly, alternative therapies such as acupuncture, moxibustion, yoga, and spinal manipulation are also gaining popularity in the treatment of FAPDs.

Functional Dyspepsia in the Elderly

PURPOSE OF REVIEW

Functional dyspepsia is a common condition, and the condition is defined by symptoms using Rome IV criteria. This review addresses the issue of functional dyspepsia in elderly patients, epidemiology, investigation, and treatment.

RECENT FINDINGS

Recent studies show that while the prevalence of dyspepsia declines in the elderly, it is still prevalant investigations to confirm the diagnosis (including mandatory upper gastrointestinal endoscopy) must exclude organic disease. These include ulcers (particularly associated with nonsteroidal antiinflammatory drugs), Helicobacter pylori pathologies, cancer, coeliac disease, and autoimmune gastritis. Recent research is unraveling pathophysiology beyond symptom-only definitions, focusing on the duodenum with innate immune disturbance (duodenal eosinophilia) and microbial disruption as possible cause. Management of functional dyspepsia includes making a secure diagnosis, treatment with first-line proton pump inhibitors (PPI), then tricyclic antidepressants, and careful choice of prokinetics. Herbal treatments (peppermint oil) and STW-5 have in this age group limited efficacy. Further studies are needed to define the prevalence of functional dyspepsia in the elderly and of prime importance, to exclude organic disease as a cause for symptoms of dyspepsia.