Peppermint Oil for the Treatment of Irritable Bowel Syndrome

A Systematic Review and Meta-analysis

Khanna, Reena MD^*; MacDonald, John K. MA^*; Levesque, Barrett G. MD, MS^†

^*Robarts Clinical Trials, Robarts Research Institute, The University of Western Ontario, London, ON, Canada

^†Division of Gastroenterology, University of California San Diego, La Jolla, CA

J.K.M. has received fees for consultancy from Tillotts Pharma AG. B.G.L. has received fees for consultancy from Santarus Inc. and Prometheus Labs; speakers bureau payments from UCB Pharma, Salix and Warner Chilcott; and payment for development of educational presentations from Curatio. The remaining author declares that she has nothing to disclose.

Reprints: Barrett G. Levesque, MD, MS, Division of Gastroenterology, University of California San Diego, 9500 Gillman Drive, La Jolla, CA 92093-0956 (e-mail:[email protected]).

Received April 3, 2013

Accepted August 2, 2013

Journal of Clinical Gastroenterology48(6):p 505-512, July 2014. |DOI:10.1097/MCG.0b013e3182a88357

Abstract

Goals:

The aim of this study was to assess the efficacy and safety of enteric-coated peppermint oil capsules compared with placebo for the treatment of active irritable bowel syndrome (IBS).

Background:

IBS is a common disorder that is often encountered in clinical practice. Medical interventions are limited and the focus is on symptom control.

Study:

Randomized placebo-controlled trials with a minimum treatment duration of 2 weeks were considered for inclusion. Cross-over studies that provided outcome data before the first cross-over were included. A literature search upto February 2013 identified all applicable randomized-controlled trials. Study quality was evaluated using the Cochrane risk of bias tool. Outcomes included global improvement of IBS symptoms, improvement in abdominal pain, and adverse events. Outcomes were analyzed using an intention-to-treat approach.

Results:

Nine studies that evaluated 726 patients were identified. The risk of bias was low for most of the factors assessed. Peppermint oil was found to be significantly superior to placebo for global improvement of IBS symptoms (5 studies, 392 patients, relative risk 2.23; 95% confidence interval, 1.78-2.81) and improvement in abdominal pain (5 studies, 357 patients, relative risk 2.14; 95% confidence interval, 1.64-2.79). Although peppermint oil patients were significantly more likely to experience an adverse event, such events were mild and transient in nature. The most commonly reported adverse event was heartburn.

Conclusions:

Peppermint oil is a safe and effective short-term treatment for IBS. Future studies should assess the long-term efficacy and safety of peppermint oil and its efficacy relative to other IBS treatments including antidepressants and antispasmodic drugs.