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The lower gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Peppermint oil results in improvement in global symptoms of IBS, with benefit seen in almost three quarters of patients [23]. It is very well tolerated, with generally only trivial side effects. The main reported side effect is heartburn [24]. Iberogast, which is a preparation of nine different herbs, has also been shown in a number of studies to improve global symptoms of IBS. It is also very well tolerated [25].
Gastroenterology
Published in Hilary McClafferty, Integrative Pediatrics, 2017
Iberogast (manufactured by STW-5-Medical Futures Inc. Richmond Hill, Ontario, Canada), on the commercial market for more than five decades, is a compound product consisting of nine herbal extracts. In adults it has been found to be effective in small studies for functional dyspepsia and irritable bowel syndrome. Components include a proprietary blend of chamomile flower, lemon balm leaf, bitter candy tuft, caraway fruit, licorice root, angelica root, milk thistle fruit, peppermint leaf, and greater celadine herb. Adverse events have not been reported. To date, no randomized controlled trials exist in children (Ottillinger et al. 2013).
Nutritional Management of Upper Gastrointestinal Disorders
Published in Mary J. Marian, Gerard E. Mullin, Integrating Nutrition Into Practice, 2017
Francis Okeke, Bani Chander Roland
Other nutritional remedies that have been used in the management of gastroparesis include the following: Ginger formulations—these usually help with nausea in some patients and have evidence to improve gastroparesis when using 1500 mg daily in divided doses [54].Peppermint formulations—also known to help with nausea and has also been reported to accelerate the early phase of gastric emptying, increase the relaxation time of the pylorus, and decrease the resting pressure of the LES [17].Iberogast (STW 5)—this is a combination of nine herbs, which have different effects on the stomach including inhibitory effects on the proximal stomach and increased motility of the distal stomach [55]. Large prospective studies are needed to determine any therapeutic benefits of Iberogast in patients with gastroparesis.Melatonin—close to 500× more melatonin is synthesized in the GI tract than in the pineal gland [56]. Studies of the effects of melatonin on the GI tract have included its effect on GERD symptoms [2,10,11], and colonic transit times [57], but large-scale prospective studies are needed to look at these effects in patients with gastroparesis.Cinnamon—in one study was shown to delay gastric emptying if taken in doses of up to 6 g or higher, but was also shown to reduce the postprandial glucose response [58].Tangweikang (TWK)—this traditional Chinese herb showed promise in a study investigating its effects on diabetic gastroparesis and was significant in symptom improvement clinically, increasing gastric emptying rate, shortening gastric emptying time, enhancing GI kinetics, and also postprandial glucose control.
Duodenal inflammation: an emerging target for functional dyspepsia?
Published in Expert Opinion on Therapeutic Targets, 2020
Lucas Wauters, Grace Burns, Matthias Ceulemans, Marjorie M Walker, Tim Vanuytsel, Simon Keely, Nicholas J Talley
Mirtazapine is a tetracyclic antidepressant which blocks the presynaptic α2-noradrenergic receptors, resulting in more noradrenaline and 5-HT release [140]. Additional receptor affinities include 5-HT-3-receptor antagonism with anti-nausea effects (in contrast to venlafaxine) and both H1- and 5-HT-2 c-receptor antagonism with increased appetite, weight gain, and sedation. These effects were confirmed in a Belgian study with significant improvement of PDS-type symptoms, quality of life, and nutrient tolerance in FD patients with weight loss and no anxiety or depression [144]. In addition, GI-specific anxiety was reduced, which may be secondary to improved gastric function or changes in duodenal barrier function, as a correlation was also found between permeability and GI-specific anxiety in another FD cohort [25]. Besides increased appetite, improved gastric accommodation may occur via 5-HT-2 c-receptor antagonism and the effect of H1-receptor antagonism on duodenal mast cells and resulting duodeno-gastric reflexes requires further study. Finally, herbal medicine or phytotherapy has been studied in FD patients with the promise of a broader range of pharmacological effects as well as patient acceptance and tolerance. Iberogast (STW5) is composed of nine different extracts (e.g. Iberis, peppermint, chamomile) and was more efficacious than placebo with regard to the severity of the most bothersome GI symptom [145], although its effect on EPS- or PDS-type symptoms and comparative efficacy with existing medical therapies remains to be established.
A comparative study of ranitidine and quince (Cydonia oblonga mill) sauce on gastroesophageal reflux disease (GERD) in pregnancy: a randomised, open-label, active-controlled clinical trial
Published in Journal of Obstetrics and Gynaecology, 2018
Afsaneh Shakeri, Mohammad Hashem Hashempur, Mahdieh Mojibian, Fatemeh Aliasl, Soodabeh Bioos, Fatemeh Nejatbakhsh
Iberogast is another popular herbal remedy for a variety of GE diseases. However, a meta-analysis which focussed on its efficacy concluded that it has no promising effect on GERD treatment (Melzer et al. 2004). Another medicinal herb for the GERD management is Myrtus communis. In a clinical trial by Zohalinezhad et al. (2016) a freeze-dried powder of myrtle was used for patients with GERD. Myrtle had the same efficacy in comparison with omeprazole (Zohalinezhad et al. 2016). There are several herbs which were reported as the popular natural home remedies for pregnancy-related GERD. For example, ginger, chamomile, thyme, valerian, fenugreek, green tea, and olibanum are used worldwide for this disease. However, there are trace data about their safety and efficacy. Hence, an evidence-based approach is necessitated (Holst et al. 2011; John and Shantakumari 2015; Kennedy et al. 2013; Qasemzadeh et al. 2015).
Current and emerging therapeutic options for the management of functional dyspepsia
Published in Expert Opinion on Pharmacotherapy, 2020
A. Vandenberghe, J. Schol, K. Van den Houte, I. Masuy, F. Carbone, J. Tack
Iberogast, a herbal preparation containing different herbs is commonly administered both in IBS and FD, with the aim of relieving spasmodic and painful sensations of the stomach and the large bowel [68]. The available controlled studies with iberogast in FD showed statistical superiority over placebo [69–71]. Worldwide experience suggests iberogast is quite safe, although a recent case report of putative iberogast-induced liver failure appeared [72].