Irritable Bowel Syndrome
• Spastic Colon
• Flaxseed, Peppermint Oil, Probiotics, Traditional Chinese Herbal Medicine
• Acupuncture, Avoidance of Allergenic Foods, Coleus forskohlii, Digestive Enzymes (Including Bromelain and Other Proteolytic Enzymes ) , Fructo-oligosaccharides, Glutamine, Hypnotherapy, Melatonin, Relaxation Therapy, Slippery Elm
The term IBS is used to describe chronic colon problems that occur in the absence of an identifiable medical cause. Common symptoms include alternating diarrhea and constipation, excess intestinal gas, intestinal cramping, uncomfortable bowel movements, abdominal discomfort following meals, and excessive awareness of the presence of stool in the colon. Despite all these distressing symptoms, in IBS, the intestines appear to be perfectly healthy when they are examined. Thus the condition belongs to a category of diseases that physicians call “functional.” This means that while the function of the bowel seems to have gone awry, no injury or disturbance of its structure can be discovered. (The analogous problem in the stomach is called dyspepsia , and the two conditions frequently overlap.)
Because the cause of IBS is not understood, conventional medical treatment of IBS is highly inadequate. One drug that had shown promise, Zelnorm, was withdrawn from the market for safety issues. Another, Lotronex, was temporarily withdrawn, and then re-approved, but only under strict limitations. Other medical treatment approaches for IBS include increased dietary fiber, drugs that reduce bowel spasm, and drugs to address constipation or diarrhea as needed. In addition, various forms of psychotherapy, including hypnosis, have been tried, with some success. 1-6
Principal Proposed Natural Treatments
Peppermint oil is widely used for IBS. While the research evidence is a bit inconsistent, 9 out of 13 placebo-controlled studies found peppermint oil more effective than placebo. 7-12,34,49 However, most studies were small.
For more information, including dosage and safety issues, see the full Peppermint article.
For example, in a 6-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, in which constipation is a more significant symptom than diarrhea, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency. 50 In another randomized trial, 266 women with constipation who consumed yogurt containing Bifidobacterium animalis and the prebiotic fructo-oligosaccharide twice daily for two weeks experienced significant improvement in their symptoms compared to women consuming regular yogurt as a placebo.60Prebiotics are substances that encourage the growth of beneficial bacteria in the colon.
Another study examined the effects of 4 weeks treatment with L. plantarum on intestinal gas in 60 people with IBS. This study found benefits that persisted for an entire year after treatment stopped. 15
Benefits were seen in five other small, double-blind trials as well, using L. plantarum , 25, 27L. acidophilus , 16,55Lactobacillus rhamnosus , 47L. salivarus , 51 and Bifidobacterium , 51 as well as proprietary probiotic combinations including various strains. 28,35,54
However, there have been a number of negative studies as well.26,36,57
Two studies that pooled previous randomized trials on the use of probiotics for IBS came to similar conclusions: probiotics appear to offer some benefit, most notably for global symptoms and abdominal discomfort. However, these two studies were unable to determine which probiotic species were most effective.58,59
For more information, see the full Probiotics article.
In a double-blind study, 55 people with chronic constipation caused by IBS received either ground flaxseed or psyllium seed (a well-known treatment for constipation) daily for 3 months. 17 Those taking flaxseed had significantly fewer problems with constipation, abdominal pain, and bloating than those taking psyllium. The flaxseed group had even further improvements in constipation and bloating while continuing their treatment in the 3 months after the double-blind study ended. The researcher concluded that flaxseed relieved constipation more effectively than psyllium.
For more information, see the Flaxseed article.
Chinese Herbal Medicine
Chinese herbal medicine is traditionally practiced in a highly individualized way, with herbal formulas tailored to the exact details of each person’s case. In a double-blind, placebo-controlled trial, 116 people with IBS were randomly assigned to receive individualized Chinese herbal treatment, a “one-size-fits-all” Chinese herbal formulation, or placebo. 29 Treatment consisted of 5 capsules 3 times daily, taken for 16 weeks. The results showed that both forms of active treatment were superior to placebo, significantly reducing IBS symptoms. However, the individualized treatment was no more effective than the “generic” treatment. Similar results were seen in another study as well. 44
For more information on this complex medical system, including important safety issues, see the Traditional Chinese Herbal Medicine article.
Other Proposed Natural Treatments
One study found evidence that pancreatic digestive enzymes (including proteolytic enzymes plus other enzymes called lipases) might be helpful for reducing the flare-up of IBS symptoms that may follow a fatty meal. 30
Three small studies suggest that use of the supplement melatonin might reduce symptoms of IBS; 38-39,46 it has been suggested that the hormone melatonin may have an effect on the nervous system in the digestive tract.
The prebiotic supplement fructo-oligosaccharides has been advocated as a treatment for IBS. However, research results are currently inconsistent at best. For example, a s6-week, double-blind study of 105 people with mild irritable bowel syndrome compared 5 g of fructo-oligosaccharides daily against placebo, and returned conflicting results. 52 According to some measures of symptom severity employed by the researchers, use of FOS led to an improvement in symptoms; however, according to other measures, FOS actually worsened symptoms. 19 Conflicting results, though of a different kind, were also seen in a 12-week, double-blind, placebo-controlled study of 98 people. 41 Treatment with FOS at a dose of 20 g daily initially worsened symptoms, but over time this negative effect wore off. At no time in the study were clear benefits seen, however. On a positive note, one study did find benefit with a combination prebiotic-probiotic formula. 42
Acupuncture has been proposed as a treatment for IBS. However, study results have thus far failed to show it effective. For example, a 13-week study of 60 people with IBS found fake acupuncture just as beneficial as traditional acupuncture. 32 Two other studies also failed to find benefit. 33,43
For a discussion of homeopathic approaches to irritable bowel syndrome, see the Homeopathy database.
2. Palsson OS, Turner MJ, Johnson DA. Hypnotherapy for irritable bowel syndrome: symptom improvement and autonomic nervous system effects. Poster presented at: Digestive Disease Week 2000; May 21-24, 2000; San Diego, CA.
15. Nobaek S, Johansson ML, Molin G, et al. Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Am J Gastroenterol. 2000;95:1231-1238.
24. Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892-1897.
25. Niedzielin K, Kordecki H, Birkenfeld B. A controlled, double-blind, randomized study on the efficacy of Lactobacillus plantarum 299V in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2001;13:1143-1147.
28. Kim HJ, Camilleri M, McKinzie S, et al. A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895-904.
35. Kim HJ, Vazquez Roque MI, Camilleri M, et al. A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating. Neurogastroenterol Motil. 2005;17:687-696.
36. Niv E, Naftali T, Hallak R, et al. The efficacy of Lactobacillus reuteri ATCC 55730 in the treatment of patients with irritable bowel syndrome-a double blind, placebo-controlled, randomized study. Clin Nutr. 2005 Jul 26. [Epub ahead of print]
38. Song GH, Leng PH, Gwee KA, et al. Melatonin improves abdominal pain in irritable bowel syndrome patients who have sleep disturbances: a randomised double blind placebo controlled study. Gut. 2005 May 24. [Epub ahead of print]
39. Lu WZ, Gwee KA, Moochhalla S, et al. Melatonin improves bowel symptoms in female patients with irritable bowel syndrome: a double-blind placebo-controlled study. Aliment Pharmacol Ther. 2005;22:927-934.
40. Brinkhaus B, Hentschel C, Von Keudell C, et al. Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial. Scand J Gastroenterol. 2005;40:936-943.
42. Bittner AC, Croffut RM, Stranahan MC, et al. Prescript-Assist probiotic-prebiotic treatment for irritable bowel syndrome: a methodologically oriented, 2-week, randomized, placebo-controlled, double-blind clinical study. Clin Ther. 2005;27:755-761.
44. Leung WK, Wu JC, Liang SM, et al. Treatment of diarrhea-predominant irritable bowel syndrome with traditional chinese herbal medicine: a randomized placebo-controlled trial. Am J Gastroenterol. 2006;101:1574-1580
45. Vejdani R, Shalmani HR, Mir-Fattahi M, et al. The efficacy of an herbal medicine, carmint, on the relief of abdominal pain and bloating in patients with irritable bowel syndrome: a pilot study. Dig Dis Sci. 2006 Jul 26. [Epub ahead of print]
47. Gawronska A, Dziechciarz P, Horvath A, et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25:177-184.
49. Cappello G, Spezzaferro M, Grossi L, et al. Peppermint oil (Mintoil®) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007 Apr 7. [Epub ahead of print]
50. Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther. 2007;26:475-486.
52. Paineau D, Payen F, Panserieu S, et al. The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders. Br J Nutr. 2007 Aug 13. [Epub ahead of print]
54. Kajander K, Myllyluoma E, Rajilic-Stojanovic M, et al. Clinical trial: multispecies probiotic supplementation alleviates the symptoms of IBS and stabilises intestinal microbiota. Aliment Pharmacol Ther. 2007 Oct 6. [Epub ahead of print]
57. Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. A double blind randomized controlled trial of a probiotic combination in 100 patients with irritable bowel syndrome. Gastroenterol Clin Biol. 2008;32:147-152.
Last reviewed June 2008 by ESBCO CAM Review Board
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