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Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: a Systematic Review

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Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: a Systematic Review Herbal Medicines for Gastrointestinal Dennis Anheyer, MA, BSc, a Jane Frawley, PhD, b Anna Katharina Koch, MSc, a, c Romy Lauche, PhD, a,b DisordersJost Langhorst, MD, a, c Gustav Dobos, in MD, Children a Holger Cramer, PhDa, b and Adolescents: A Systematic Review CONTEXT: abstract Gastrointestinal disorders are common childhood complaints. Particular types of complementary and alternative medicine, such as herbal medicine, are commonly used OBJECTIVES: among children. Research information on efficacy, safety, or dosage forms is still lacking. To systematically summarize effectiveness and safety of different herbal DATA SOURCES: treatment options for gastrointestinal disorders in children. Medline/PubMed, Scopus, and the Cochrane Library were searched through July STUDY SELECTION: 15, 2016. – Randomized controlled trials comparing herbal therapy with no treatment, placebo, or any pharmaceutical medication in children and adolescents (aged 0 18 years) DATA EXTRACTION: with gastrointestinal disorders were eligible. Two authors extracted data on study design, patients, interventions, control RESULTS: interventions, results, adverse events, and risk of bias. FourteenPotentilla trials with erecta 1927 participants suffering from different acute and functional gastrointestinalMatricaria disorders chamomilla were included in this review. Promising evidence for effectiveness was found for , carob bean juice, and an herbal compound preparation including in treating diarrhea. Moreover, evidence was found for peppermint oil in decreasing duration, frequency, and severity of pain in children suffering from undifferentiated functional abdominal pain. Furthermore, evidence for effectiveness was found for different fennel preparations (eg, oil, tea, herbal compound) in treating LIMITATIONS: children with infantile colic. No serious adverse events were reported. Few studies on specific indications, single herbs, or herbal preparations could be CONCLUSIONS: identified. Because of the limited number of studies, results have to be interpreted carefully. To underpin evidence outlined in this review, more rigorous clinical trials are needed. aDepartment of Internal and Integrative Medicine, Kliniken Essen-Mitte, and cDepartment of Integrative Gastroenterology, University of Duisburg-Essen, Essen, Germany; and bAustralian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia Mr Anheyer conceptualized and designed the study, conducted the literature review, collected the data, created the tables and figures, and drafted the initial manuscript; Drs Cramer and Lauche participated in conceptualizing and designing the review, participated in collecting the data, and reviewed and revised the manuscript; Dr Frawley and Ms Koch participated in drafting the initial manuscript, and reviewed and revised the manuscript; Drs Dobos and Langhorst critically reviewed the manuscript; and all authors approved the final manuscript as submitted. To cite: Anheyer D, Frawley J, Koch AK, et al. Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: A Systematic Review. Pediatrics. 2017;139(6):e20170062 Downloaded from www.aappublications.org/news by guest on September 29, 2021 PEDIATRICS Volume 139, number 6, June 2017:e20170062 REVIEW ARTICLE ∼ Functional gastrointestinal disorders Whereas 52% of all children in ingredients of animal or mineral like irritable bowel syndrome Europe are using some kind of origin), the study was not included (IBS), functional abdominal pain, CAM, the use of particular types in this review. No other dosage constipation, and infantile colic of CAM, such– as herbal medicine, Srestrictionsearch Methods were made. as well as acute gastrointestinal is increasingly20, 24 27 common among disorders like gastroenteritis are children. Although herbal common childhood– complaints that medicines are commonly used, Medline/PubMed, Scopus, and research detailing information on affect a large proportion1 4 of children the Cochrane Central Register of and adolescents. Beside the painful efficacy, safety, dosage forms, and Controlled Trials (Central) were impacts for the child, gastrointestinal dose quantities is still lacking. In searched from their inception dates disorders can lead to lower quality of response, the scope of this review to July 15, 2016. Embase was not is to systematically summarize the life, school absenteeism, and a 5,higher 6 searched separately because it is risk of depression and anxiety. effectiveness and safety of different included in Scopus. Because this Parents are also affected not only herbal treatment options for article is part of a major project to because they commiserate with their gastrointestinal disorders in children identify evidence for herbal therapy offspring but also because of the and adolescents. in children, the literature search was “ ” time needed to care for their child. METHODS widely constructed around basic “ ” Therefore, gastrointestinal disorders search terms for children and in children and adolescents may lead search terms for herbal therapy. to both major reductions in quality This review was conducted in The complete search strategy of life for the child and parents– and accordance with the Preferred for PubMed/Medline is shown in Reporting Items for Systematic major socioeconomic impacts5 7 for the Supplemental Information. For each family and wider society. Reviews and Meta-Analyses database, the search strategy was guidelines and recommendations28,29 of adapted as necessary. Abstracts The management of gastrointestinal Etheligibility Cochrane Criteria Collaboration. identified during the literature search disorders in children and Types of Studies were screened, and potentially adolescents, especially functional eligible articles were read in full independently by 3 review authors gastrointestinal8, 9 disorders, can be (DA, HC, and RL) to determine if challenging. Parents often visit Randomized controlled trials (RCTs), they met eligibility criteria. After different practitioners in search randomized cross-over trials, and identifying the literature in the field of a reliable diagnosis or therapy. cluster-randomized trials were of interest, only these articles with Many available treatments are eligible. Trials were included if they children and adolescents suffering either effective but yield potential wereTypes publishedof Participants in English or German. for undesirable adverse effects, or from gastrointestinal complaints as 10 – safe but might lack effectiveness. mentioned above were taken into – Daccount.ata Extraction and Management This may lead to conflicting advice, Only studies on children (0 12 years different prescribed treatments,7, 11, and 12 of age) or adolescents (13 18 years high direct and indirect costs. of age) were included if patients In this context, a high prevalence suffered from gastrointestinal Extraction of data on methods, of complementary and alternative complaints such as diarrhea, patients (eg, age, sex, diagnosis), medicine (CAM) use can be observed– constipation, colic, IBS, inflammatory interventions (herbs, dose, etc), control interventions, and results among patients suffering from13 16 bowel diseases, and other disorders gastrointestinal disorders. ofTypes the ofgastrointestinal Interventions tract. was performed by 2 review authors Research suggests that parents (DA and RL) independently by often favor CAM products, such using an a priori-developed data as herbal medicine, in the belief Studies that compared herbal extraction form. Discrepancies were rechecked with a third reviewer (HC) they 17are natural and therefore medicines with treatment-as-usual safe. In addition to this, evidence or other active comparators, placebo, and discussed until consensus was suggests some parents may also be or no treatment were eligible. If Riskachieved. of Bias in Individual Studies dissatisfied or fear the side effects18 the herbal drug was applied only in of conventional medication. As a homeopathic potency or if the herb result, parents– often do not disclose is exclusively used in traditional By using the Cochrane risk of bias the use of CAM19 23to the attending Chinese medicine (so-called Chinese tool, the risk of bias of each included pediatrician. herbal medicine often includes study was assessed by 2 authors Downloaded from www.aappublications.org/news by guest on September 29, 2021 2 ANHEYER et al (DA and HC) independently. This tool assesses risk of bias by using 7 criteria (rating: low, unclear, or high risk of bias): random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases. Discrepancies were rechecked with a third reviewer and discussed until consensus was achieved. Trial authors were contacted for further details if necessary. RESULTS Literature Search Literature search retrieved 10083 nonduplicate records, of which 259 full texts were assessed for eligibility. Eighty-six of them were considered to be eligible for the whole field of herbal medicine in children and adolescents, whereas 173 full texts were excluded for the following reasons: they were not RCTs, the investigated herbs were exclusively FIGURE 1 used in traditional Chinese medicine, Flowchart of the results of the literature search. the herbal drug was applied only in homeopathic potency, or the study had no participants between 0 and M chamomilla adequate allocation concealment.
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