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Peppermint Oil: Clinical Uses in the Treatment of Gastrointestinal Diseases

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Peppermint Oil: Clinical Uses in the Treatment of Gastrointestinal Diseases Central JSM Gastroenterology and Hepatology Research Article *Corresponding author David A. Johnson MD, MACG, FASGE, FACP 885 Peppermint Oil: Clinical Kempsville Road, Suite 114, Norfolk, VA 23502; Email: Submitted: 10 November 2014 Uses in the Treatment of Accepted: 13 January 2015 Published: 19 January 2015 Copyright Gastrointestinal Diseases © 2015 Johnson et al. Rouzbeh Shams1, Edward C. Oldfield2, Jennifer Copare3 and OPEN ACCESS David A. Johnson4* Keywords 1Department of Internal Medicine, Eastern Virginia Medical School, United States • Peppermint oil 2Department of Internal Medicine, Eastern Virginia Medical School, United States • Irritable bowel syndrome 3Department of Internal Medicine, Eastern Virginia Medical School, United States • Functional dyspepsia 4Department of Internal Medicine Gastroenterology, Division Eastern Virginia Medical • Spasmolytic School, United States Abstract Peppermint oil has been used for centuries as a remedy for nausea, indigestion, and a host of other medical symptoms. Over the course of the past several years, studies have looked at the benefit of peppermint oil in Irritable Bowel Syndrome, functional dyspepsia and endoscopy and barium-induced spasm of the gastrointestinal tract. The benefit of peppermint oil is thought to be due to anti-spasmodic effects, as well as anti-inflammatory and anti-bacterial effects. Although more research may be beneficial, peppermint oil shows evidence justifying a more expanded using gastrointestinal disease management. This review focuses on the physiology and recent literature illustrating potential use of peppermint oil. INTRODUCTION discomfort occurring at least 3 days a month in the last 3 months, Peppermint oil is derived from the peppermint plant, a associated[6]. Clinically, with IBS two is ordefined more of:by improvementrecurrent abdominal with defecation, pain or cross between water mint and spearmint, which is indigenous onset associated with a change in frequency of stool, onset to Europe and North America but now grown throughout the associated with a change in the form (appearance) of stool world. Chemically, peppermint oil is made up of primarily of menthol and the structurally similar compound menthone [1]. Although peppermint oil is most commonly associated with its increased[7]. The treatment rates of ofpsychiatric IBS can beconditions, quite complex namely given depression a poor understanding behind the exact etiology and an association with remedy for a variety of symptoms such as nausea, indigestion, focused on symptomatic control, there are also a number of using flavoring or fragrance, it has long been used as a home and headaches [1]. Since 1979, peppermint oil has been clinically complementaryand anxiety [8,9]. and With alternative pharmacologic medicine management treatments primarily being studied for symptomatic treatment of certain gastrointestinal practiced and reviewed for IBS. Peppermint oil is one of these conditions, including Irritable Bowel Syndrome (IBS), dyspepsia, treatment approaches to IBS currently gaining attention based and in preparation for endoscopic procedures [1,2]. Additionally, there is some promising data suggesting that peppermint oil may controlled trials. on its documented physiologic effects and efficacy in randomized Physiology be beneficial via anti-spasmotic, anti-inflammatory and anti- bacterial properties [3-5]. These properties, combined with a based on its documented effects as a spasmolytic agent. Early relatively minimal side effect profile make it a favorable treatment studiesThe onuse peppermint of peppermint oil using oil in electrophysiology the treatment of in IBS a guinea is largely pig option. This article will address the use of peppermint oil in peppermintirritable bowel oil insyndrome, relation to functional each, followed dyspepsia, by a discussion and endoscopy- of the induced spasm by first reviewing the pertinent physiology of available clinical data. amplitudesmodel showed while that also peppermint increasing oil the exerts rate of an current effect decay;on potential- in this manner,dependent peppermint calcium oilchannels has a mechanism by decreasing of action the resembling peak current that IRRITABLE BOWEL SYNDROME Irritable Bowel Syndrome is a functional gastrointestinal eppermint oil is able to induce smooth of a dihydropyridine calcium channel antagonist [10]. By reducing the calcium influx, p illness affecting between 5-20% of the world’s population muscle relaxation within the gastrointestinal tract. In order to Cite this article: Shams R, Oldfield EC, Copare J, Johnson DA (2015) Peppermint Oil: Clinical Uses in the Treatment of Gastrointestinal Diseases. JSM Gas- troenterol Hepatol 3(1): 1036. Johnson et al. (2015) Email: Central achieve this effect, the peppermint oil must be formulated with ) and a delayed release enteric coating to ensure delivery to the lower PGE2 (Prostaglandin E2 4 4 GI tract and colon [11,12]. Additionally, inappropriate release arachidonic acid metabolism into LTB (leukotriene B ), which served as markers for the lipooxygenase and cyclooxygenase pathways, respectively [5]. 2 4 heartburn,of the peppermint the primary oil in adversethe upper effects GI tract of inducespeppermint relaxation oil [12]. of Results showed that L-menthol significantly inhibited LTB (-64.4 the lower esophageal sphincter leading to resultant reflux and ± 10%), PGE (-56.6 ± 8%), and IL-1β (-64.2-7 ± 7%) production oil are available, the two formulations in particular which have agentat low [11]. doses Peppermint (therapeutic oil rangehas also of 10been g/ml) documented and in toa dose-have beenWhile predominately a number of entericused in coatedclinical formulationstrials are Colpermin of peppermint (McNeil antibacterialdependent manner, activity therebyin vitro againstserving overas an 22 anti-inflammatorydifferent bacteria Healthcare, Dublin, Ireland) and Mint oil (Cadigroup, Rome, the way in which the peppermint oil is prepared. Colpermin uses toincluding inhibit gram-positivethe proliferation cocci of Helicobacterand rods and pylori, gram-negative Salmonella Italy) [13]. The main difference between these two products is enteritidis,bacteria [17-19]. Escherichia Additionally, coli 0157:H7, peppermint and bothoil wasmethicillin shown sensitive and methicillin resistant Staphylococcus aureus in liquid 0.2mL of peppermint oil in an enteric coated capsule, whereas Mint oil uses 225mg of peppermint oil and 45mg of Natrasorb, a bacterial overgrowth (SIBO) and IBS, the antimicrobial activity particular tapioca starch that absorbs oils in solid powder [14]. ofcultures peppermint [20] Given oil in the the relationship small intestine between may smallprovide intestinal anther There are no currently available studies comparing the efficacy mechanism for symptomatic improvement in IBS [21] of delivery for the two formulations. The dose of peppermint oil inhowever, outcomes is essentiallyto be attributed equivalent to the (0.2mL level of = dosing 200mg) used between in the Clinical Trials variousthe two trials,products. and notAs a to result, the choice one would of formulation. expect any differences In 1979, Rees et al originally documented the use of peppermint oil for the treatment of IBS by enrolling 18 patients of theThe melastatinactivity of peppermintsubfamily ofoil transienton calcium receptor channels potential may be more specifically related to the mediation ofTRPM8, a member with IBS (no identification of subtype provided)to receive either 0.2 mL of peppermint oil in gelatin capsules (Elanco LOK caps, Eli cold temperatures and also menthol, the main constituent of trial period [2] Despite showing no effect on stool frequency, (TRP) cation channel super family, which can be activated by symptomLilly and Co analysis Ltd/Indianapolis/USA) revealed a lower total or placebo and mean for daily a three-week symptom contractions of smooth muscle in a manner inversely proportional peppermint oil [15]. The activation of the TRPM8 channels induces the small number of participants. to the temperature and also through a mechanism involving the score, however, this did not achieve clinical significance due to activation of Rho-kinase; Rho-kinase inhibits myosin light change Nearly 20 years later, Pittler and Ernst published one of the channels(MLC) phosphatase, have been allowingfound in fordorsal phosphorylation root ganglia, ofvagal MLC afferent kinase first critical reviews and meta-analysis on peppermint oil in and subsequent smooth muscle contraction [16]. These TRPM8 IBS [22]. They identified eight randomized control trials, five is, however, some controversial evidence concerning the ability peppermintof which were oil comparedplacebo-controlled, with placebo double-blind in symptomatic trials. treatment Overall, ofneurons, menthol the to gastric induce fund a release us, colon, of intracellular and small calciumintestine stores [3]. There from the meta-analysis suggested a significantly positive effect of calcium release was potentiated at high temperatures, opposite of (P < 0.001), based on three studies with a positive effect and the TRPM8 channels, as one study found that menthol-induced two without any significant difference; however, the authors concluded that significant methodological flaws associated with fromthe cold the activation endoplasmic of TRPM8 reticulum [4]. Additionallyand Golgi bodies, these researchersin contrast the majority of the studies excluded establishing a benefit of found that menthol-induced calcium release primarily originates
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