Standardized herbal treatments on functional bowel disorders: moving from putative mechanisms of action to controlled clinical trials

Abstract

Symptom relief in functional gastrointestinal disorders (FGID) is frequently sought with complementary and alternative medicine, and various herbal medicine compounds are popular in different parts of the world. Only a few products, however, are standardized and are backed by scientific evidence. This review mainly focuses on mechanistic and clinical data in support of the Japanese traditional compound Rikkunshi-to (RKT) and of STW-5. Their effects on gut sensori-motor function, neurohormonal network, and controlled clinical data in FGID are revised. RKT and STW-5 appear to possess some degree of gastroprokinetic, visceral analgesic properties, and seem to increase the gastric accommodation response. Controlled trials of RKT and STW-5 support at least a modest effect on symptoms of functional dyspepsia and irritable bowel syndrome, with low side effects profile. With the widespread use of herbals and the relative paucity of effective pharmacological options for FGID, rigorous studies to further elucidate pharmacological actions and clinical applications of herbal compounds are a priority.

Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta‐analysis

“…HMs have been reported to produce a synergy of therapeutic effects, e.g. spasmolytic, tonicizing, carminative, anti‐inflammatory and local analgesic …”

“…It also exhibits anti‐stress effects by attenuating the hypothalamic–pituitary‐adrenocortical axis and sympathetic activation. Besides, It was also effective for the extra‐gastric symptoms of patients with FD or IBS, such as dizziness, coldness in the lower extremities, or general fatigue …”

“…spasmolytic, tonicizing, carminative, anti-inflammatory and local analgesic. 66,67 Several HMs are promising in giving new treatment opportunities in routine clinical practice with a high prevalence of overlap of FGIDs, such as rikkunshito, STW 5, and peppermint oil with their multi-target effects. As a Kampo medicine, rikkunshito (also known as Liu-Jun-Zi-Tang in China) improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion.…”

“…Besides, It was also effective for the extra-gastric symptoms of patients with FD or IBS, such as dizziness, coldness in the lower extremities, or general fatigue. 66 On the other hand, STW 5 (Iberogast) and peppermint oil have been comprehensively studied for the treatment of FGIDs of the upper and lower abdomen. They exert different proven pharmacological effects (normalize gastrointestinal motility, alleviate hypersensitivity, inhibit inflammation, suppress gastric over-secretion, and modulate the microbiota) on different regions of the gastrointestinal tract and thus address the whole symptom complex of FD and IBS.…”

Effects of Quince syrup on clinical symptoms of children with symptomatic gastroesophageal reflux disease: A double-blind randomized controlled clinical trial

“…Met-analysis mode of research has shown that the mentioned syrup has been effective in removing symptoms of GERD (53,54). The other plant is Myrtus communis L. a pharmaceutical dosage form of Myrtus communis L. (myrtle) was compared with omeprazole and it showed the same efficacy in relieving the GERD symptoms (28).…”