Some herbal medicines improve typical symptoms such as pain, a feeling of pressure, heaviness and fullness in patients with functional dyspepsia and have also proven to be very well tolerated. This also includes a high-quality, high-dose combination of peppermint oil and caraway oil, which convinced with clear evidence in a Cochrane Review published in 2023.
The physiopathology of functional dyspepsia (FD) is multifactorial and not fully understood. Psychological stress, visceral hypersensitivity, dysfunction of the duodenal mucosal barrier and delayed gastric emptying, as well as a possible H. pylori infection are just some of the components of this disease [1–3]. There is no standard treatment that is effective in all FD cases. In addition to the use of synthetic medications such as proton pump inhibitors (PPI), prokinetics, etc., many patients also try treatment with phytotherapeutic products [4]. A Cochrane Review by Baez et al. aimed to evaluate as objectively as possible how different herbal preparations affect FD symptoms. The evaluation included a total of 41 randomized controlled double-blind studies with 4477 participants, in which 27 herbal medicines (no TCM preparations) were used. The global dyspepsia symptoms, the occurrence of adverse events and the quality of life, if recorded, were evaluated. The peppermint oil-cumin oil combination and curcuma were found to have moderate evidence-based efficacy. These treatment options therefore performed better than the Iberis-amara combinationSTW 5, for example.
Randomized controlled studies on Carmenthin®
In the analysis of three placebo-controlled studies conducted with the proprietary peppermint oil-caraway oil combination menthacarin (Carmenthin®) in a total of 305 outpatients, the authors found evidence of a moderate to large benefit in terms of dyspepsia symptoms and quality of life [4–7]. They also reported that there were only minor differences in the rate of adverse effects between the intervention and placebo.
The results of the secondary analysis indicate that the active ingredient combination of peppermint and caraway oil leads to a strong improvement in global dyspepsia symptoms after four weeks compared to placebo (SMD -0.87; 95% CI -1.15 to -0.58; 2 studies, N=210). This can also be concluded from the results on the risk ratio (RR) (RR 1.53; 95% CI: 1.30-1.81; 3 RCTs; n=305) (Table 1). Although the frequency of adverse events is slightly higher in the treatment arms, these were mostly mild side effects, some of which could be reduced by taking the preparation half an hour before a meal with a glass of still water [4–8]. In summary, the results of this Cochrane Review are further evidence that the efficacy and tolerability of Carmenthin® are supported by scientific evidence [4–8]. The phytotherapeutic agent is approved by health insurance companies in Switzerland for adults and adolescents aged 12 and over [8].
Literature:
- Tack J, Bisschops R, Sarnelli G: Pathophysiology and treatment of functional dyspepsia. Gastroenterology 2004; 127(4): 1239-1255.
- Komori K, et al: The altered mucosal barrier function in the duodenum plays a role in the pathogenesis of functional dyspepsia. Digestive Diseases and Sciences 2019; 64(11): 3228-2339.
- Vanheel H, et al: Pathophysiological Abnormalities in Functional Dyspepsia Subgroups According to the Rome III Criteria. American Journal of Gastroenterology 2017; 112(1): 132-140.
- Báez G, et al: Non-Chinese herbal medicines for functional dyspepsia. Cochrane Database of Systematic Reviews 2023, Issue 6. Art. No.: CD013323. DOI: 10.1002/14651858.CD013323.pub2.
- Chey WD, et al: A Novel, Duodenal-Release Formulation of a Combination of Caraway Oil and L-Menthol for the Treatment of Functional Dyspepsia: a Randomized Controlled Trial. Clin Transl Gastroenterol 2019; 10(4): e00021.
- Rich G, et al: A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterology and Motility 2017; 29(11): 1-9.
- May B, Kohler S, Schneider B: Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Alimentary Pharmacology and Therapeutics 2000; 14(12): 1671-1677.
- Swissmedic: Medicinal product information, www.swissmedicinfo.ch,(last accessed 12.01.2024)
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