A Novel Delivery System of Peppermint Oil Is an Effective Therapy for Irritable Bowel Syndrome Symptoms

• Published in: Digestive diseases and sciences Vol. 61; no. 2; pp. 560 - 571
• Main Authors: Cash, Brooks D., Epstein, Michael S., Shah, Syed M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2016; Springer; Springer Nature B.V
• Subjects: Adult; Biochemistry; Care and treatment; Double-Blind Method; Female; Gastroenterology; Gastrointestinal agents; Hepatology; Humans; Irritable bowel syndrome; Irritable Bowel Syndrome - drug therapy; Male; Medicine; Medicine & Public Health; Mentha piperita; Middle Aged; Oncology; Original; Original Article; Parasympatholytics - administration & dosage; Parasympatholytics - adverse effects; Parasympatholytics - therapeutic use; Plant Oils - administration & dosage; Plant Oils - adverse effects; Plant Oils - therapeutic use; Pneumoviridae; Transplant Surgery; Abdominal pain; Diarrhea; menthol; Peppermint oil; Irritable bowel syndrome; Bloating; L-menthol
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-015-3858-7

Background
Peppermint oil (PO) has shown promise as an IBS therapy, but previous trials have demonstrated variable efficacy and tolerability results.
Aims
To evaluate the efficacy and tolerability of a novel formulation of PO designed for sustained release in the small intestine in patients with IBS-M and IBS-D.
Methods
This is a 4-week, randomized, double-blind, placebo-controlled clinical trial of PO or identical placebo 3 times daily in patients fulfilling Rome III criteria for IBS-M or IBS-D. The primary endpoint was the change from baseline in the Total IBS Symptom Score (TISS) after 4 weeks of treatment.
Results
Seventy-two patients (mean age 40.7 years, 75 % female, 77.8 % white) were randomized to PO (
n
 = 35) or placebo (
n
 = 37). At 4 weeks, PO was associated with a 40 % reduction in the TISS from baseline (mean change −1.16, SD ± 0.807), superior to the 24.3 % decrease (mean change −0.70, SD ± 0.737) observed with placebo (
P
 = 0.0246). The decrease in the TISS of 19.6 % (mean change −0.55, SD ± 0.613) in the PO group at 24 h was also significantly larger than placebo (−10.3 %, mean change −0.27, SD ± 0.342) (
P
 = 0.0092). At trial completion, patients in the PO group experienced greater improvement in multiple individual gastrointestinal symptoms as well as in severe or unbearable symptoms, compared to placebo. PO was well tolerated with few adverse events.
Conclusions
A novel PO formulation designed for sustained release in the small intestine is a safe, effective treatment capable of providing rapid relief of IBS symptoms.