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      The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data

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          Abstract

          Background

          Peppermint oil (PO) has intrinsic properties that may benefit patients with irritable bowel syndrome (IBS) symptoms. The study objective was to determine the effect of peppermint oil in the treatment of the IBS.

          Methods

          We systematically searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), ClinicalTrials.gov, EMBASE (Ovid), and Web of Science for randomized controlled trials (RCTs) of PO for IBS. We appraised the eligible studies by the Cochrane risk of bias tool. We performed random-effects meta-analysis on primary outcomes including global improvement in IBS symptoms and abdominal pain. A PRISMA-compliant study protocol is registered in PROSPERO Register [2016, CRD42016050917].

          Results

          Twelve randomized trials with 835 patients were included. For global symptom improvement, the risk ratio (RR) from seven RCTs for the effect of PO ( n = 253) versus placebo ( n = 254) on global symptoms was 2.39 [95% confidence interval (CI): 1.93, 2.97], I 2  = 0%, z = 7.93 ( p < 0.00001). Regarding abdominal pain, the RR from six RCTs for the effect of PO ( n = 278) versus placebo ( n = 278) was 1.78 [95% CI: 1.43, 2.20], I 2  = 0%, z = 5.23 ( p < 0.00001). Overall, there were no differences in the reported adverse effects: PO (32 events, 344 total, 9.3%) versus placebo (20 events, 327 total, 6.1%) for eight RCTs; RR 1.40 [95% CI: 0.87, 2.26] I 2 = 0%, z = 1.39 ( p = 0.16). The number needed to treat with PO to prevent one patient from having persistent symptoms was three for global symptoms and four for abdominal pain.

          Conclusions

          In the most comprehensive meta-analysis to date, PO was shown to be a safe and effective therapy for pain and global symptoms in adults with IBS.

          Electronic supplementary material

          The online version of this article (10.1186/s12906-018-2409-0) contains supplementary material, which is available to authorized users.

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          Most cited references32

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          Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.

          Many cross-sectional surveys have reported the prevalence of irritable bowel syndrome (IBS), but there have been no recent systematic review of data from all studies to determine its global prevalence and risk factors. MEDLINE, EMBASE, and EMBASE Classic were searched (until October 2011) to identify population-based studies that reported the prevalence of IBS in adults (≥15 years old); IBS was defined by using specific symptom-based criteria or questionnaires. The prevalence of IBS was extracted for all studies and based on the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Of the 390 citations evaluated, 81 reported the prevalence of IBS in 80 separate study populations containing 260,960 subjects. Pooled prevalence in all studies was 11.2% (95% CI, 9.8%-12.8%). The prevalence varied according to country (from 1.1% to 45.0%) and criteria used to define IBS. The greatest prevalence values were calculated when ≥3 Manning criteria were used (14%; 95% CI, 10.0%-17.0%); by using the Rome I and Rome II criteria, prevalence values were 8.8% (95% CI, 6.8%-11.2%) and 9.4% (95% CI, 7.8%-11.1%), respectively. The prevalence was higher for women than men (OR, 1.67; 95% CI, 1.53-1.82) and lower for individuals older than 50 years, compared with those younger than 50 (OR, 0.75; 95% CI, 0.62-0.92). There was no effect of socioeconomic status, but only 4 studies reported these data. The prevalence of IBS varies among countries, as well as criteria used to define its presence. Women are at slightly higher risk for IBS than men. The effects of socioeconomic status have not been well described. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
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            A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.).

            Peppermint (Mentha piperita L.) is one of the most widely consumed single ingredient herbal teas, or tisanes. Peppermint tea, brewed from the plant leaves, and the essential oil of peppermint are used in traditional medicines. Evidence-based research regarding the bioactivity of this herb is reviewed. The phenolic constituents of the leaves include rosmarinic acid and several flavonoids, primarily eriocitrin, luteolin and hesperidin. The main volatile components of the essential oil are menthol and menthone. In vitro, peppermint has significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential. Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic and anesthetic effects in the central and peripheral nervous system, immunomodulating actions and chemopreventive potential. Human studies on the GI, respiratory tract and analgesic effects of peppermint oil and its constituents have been reported. Several clinical trials examining the effects of peppermint oil on irritable bowel syndrome (IBS) symptoms have been conducted. However, human studies of peppermint leaf are limited and clinical trials of peppermint tea are absent. Adverse reactions to peppermint tea have not been reported, although caution has been urged for peppermint oil therapy in patients with GI reflux, hiatal hernia or kidney stones.
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              American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome

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                Author and article information

                Contributors
                alammar.nuha@gmail.com
                linwang@jhu.edu
                saberi.behnam@jhmi.edu
                jnanava1@jhmi.edu
                g.holtmann@uq.edu.au
                rshi@mail.med.upenn.edu
                +1-410-502-4270 , gmullin1@jhmi.edu
                Journal
                BMC Complement Altern Med
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central (London )
                1472-6882
                17 January 2019
                17 January 2019
                2019
                : 19
                : 21
                Affiliations
                [1 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, The Division of Gastroenterology and Hepatology, , The Johns Hopkins University School of Medicine, ; 600 N. Wolfe Street, Baltimore, MD 21287 USA
                [2 ]King Khalid University Hospital, King Saud University, P.O. Box 2925, Riyadh, 11461 Saudi Arabia
                [3 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, The Johns Hopkins School of Public Health, ; Baltimore, MD USA
                [4 ]GRID grid.416167.3, The Division of Liver Medicine, Gastroenterology, , The Mount Sinai Hospital, ; New York, NY USA
                [5 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, , University of Queensland, ; QLD, Brisbane, Australia
                [6 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, , University of Pennsylvania, ; Philadelphia, PA USA
                Author information
                http://orcid.org/0000-0002-1413-3141
                http://orcid.org/0000-0003-1338-2100
                http://orcid.org/0000-0002-7157-5827
                http://orcid.org/0000-0002-8356-0278
                http://orcid.org/0000-0002-0206-2358
                http://orcid.org/0000-0001-8627-8203
                http://orcid.org/0000-0001-5317-6788
                Article
                2409
                10.1186/s12906-018-2409-0
                6337770
                30654773
                56d34d93-79d6-4025-8124-3d45ba7e11e0
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 August 2018
                : 13 December 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Complementary & Alternative medicine
                irritable bowel syndrome,ibs,peppermint oil,global symptom relief,abdominal pain,meta-analysis,prisma

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