Clinical Briefs
With Comments from John La Puma, MD, FACP
Peppermint Oil for Pediatric IBS
September 2001; Volume 4; 108
Source: Kline RM, et al. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr 2001;138:125-128.
Forty-two children with irritable bowel syndrome (IBS) were given pH-dependent, enteric-coated peppermint oil capsules or placebo in this randomized, double-blind, controlled trial. After two weeks, 75% of those receiving peppermint oil had reduced severity of pain associated with IBS. The authors conclude that peppermint oil may be used as a therapeutic agent during the symptomatic phase of IBS.
Comment
From researchers at the University of Missouri in Columbia, Hahnemann University in Philadelphia, and a private medical group in Charleston, South Carolina, this well constructed, small trial tested the hypothesis that peppermint oil capsules may ameliorate the recurrent abdominal pain of IBS. The authors note that studies of adults with IBS have recorded variable results, and IBS has been "clarified as a neurobiologic disorder affecting the autonomic, neuroendocrine and pain mechanisms." Many physicians are all too familiar with its effects on patients—diarrhea, constipation, distension, bloating, urgency, and often daily nagging abdominal pain.
Peppermint’s physiologic effects are well known to anyone who has sucked on an after-dinner mint to relieve dyspepsia, reduce flatulence, and relax the lower esophageal sphincter. Does the latter effect result in reflux? Yes, sometimes. And that’s the reason for pH-dependent, enteric-coated capsules.
In this study, 50 children met the Manning or Rome criteria for IBS, and were excluded if they were younger than 8 years of age or were receiving medication for the treatment of IBS. Both clinicians and patients ranked pain severity—parents did not complete the diaries. The placebo was arachis oil, and the treatment group received 187 mg of peppermint oil three times daily (and twice this dosage if the patient weighed more than 45 kg).
Only eight children withdrew (four of the eight patients could not swallow pills). Mean age was 12 years; 60% were females, and 83% were white. No side effects were reported by either the investigator or patients, and neurological exams were normal at the beginning and end of the study. Only pain was affected—no other symptoms of IBS were reduced.
Peppermint oil is a calcium channel blocker and a mild topical analgesic. Of note, because overall placebo response rate is about 30%, and as high as 40% in IBS research, these data showing 75% improvement are especially impressive. Of course, this is a pilot study, and a larger study is warranted.
Recommendation
If children can take medication three times daily and have recurring, abdominal IBS pain, peppermint oil seems worth a short, two-week trial. Longer use requires regular monitoring.
September 2001; Volume 4; 108
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