[Phytotherapeutic recommendations in medical guidelines for the treatment of gastroenterological diseases - a systematic review].

2024-04-11
Zeitschrift fur Gastroenterologie 62(07)
- Sandra Utz
- Miriam Bittel
- Jost Langhorst

PubMed: 38604221
DOI: 10.1055/a-2279-5045

Study Design

Type: Systematic Review

Phytotherapeutics are gaining influence in the treatment of gastroenterological diseases. Their popularity and growing evidence of efficacy contribute to their integration into medical guidelines. A systematic screening identified recommended phytotherapeutic approaches. Based on current scientific data, some recommendations for the use of phytotherapeutic agents are given. For irritable bowel syndrome the use of peppermint oil is "strongly recommended", especially for pain and flatulence. Other phytotherapeutics such as STW-5, Tibetan Padma Lax or warm caraway oil pads have proven effective in alleviating symptoms. It is "recommended" to integrate them into the treatment concept. For chronic constipation, 30g of fiber per day is recommended. Best data exists for plantago psyllium with moderate evidence and chicory inulin. In case of ulcerative colitis, plantago psyllium as well as the combination of myrrh, chamomile flower extract, and coffee charcoal can be used as a complementary treatment in maintaining remission. There is also an "open recommendation" for curcumin for both, remission induction and maintenance. Some phytotherapeutic treatments (e.g., Artemisia absintium, Boswellia serata) show evidence of effectiveness for the treatment of Crohn's disease, but data are not yet sufficient for recommendations. Cannabis-based medicines can be considered for abdominal pain and clinically relevant appetite loss if standard therapy is ineffective or contraindicated, but they should not be used for acute inflammation in active Crohn's disease. Further recommendations for other gastroenterological diseases are discussed. The safety and tolerability of the phytotherapeutics were rated as predominantly "very good" to "acceptable". Some clear recommendations for the use of phytotherapeutics to treat gastroenterological diseases show their great potential. Due to their wide range of effects, phytotherapeutics can be used very well as a complement to conventional medicines in case of complex regulatory disorders. However, further methodologically well-conducted impact studies would be helpful in order to be able to make further recommendations.

Research Insights

Boswellia→Improved Crohn Disease Symptom
Some phytotherapeutic treatments (e.g., Artemisia absintium, Boswellia serata) show evidence of effectiveness for the treatment of Crohn's disease, but data are not yet sufficient for recommendations.
Effect
Beneficial
Effect size
Small
Caraway→Improved Irritable Bowel Syndrome Symptoms
Other phytotherapeutics such as STW-5, Tibetan Padma Lax or warm caraway oil pads have proven effective in alleviating symptoms
Effect
Beneficial
Effect size
Moderate
Dose
warm caraway oil pads
Chicory→Improved Bowel Movement Frequency
For chronic constipation, 30g of fiber per day is recommended. Best data exists for plantago psyllium with moderate evidence and chicory inulin.
Effect
Beneficial
Effect size
Moderate
Dose
30g of fiber per day
Myrrh→Maintained Remission in Ulcerative Colitis
There is also an 'open recommendation' for curcumin for both, remission induction and maintenance.
Effect
Beneficial
Effect size
Moderate
Peppermint→Reduced Abdominal Pain
use of peppermint oil is 'strongly recommended', especially for pain and flatulence
Effect
Beneficial
Effect size
Moderate
Peppermint→Reduced Flatulence
use of peppermint oil is 'strongly recommended', especially for pain and flatulence
Effect
Beneficial
Effect size
Moderate
Plantain→Improved Bowel Movement Frequency
For chronic constipation, 30g of fiber per day is recommended. Best data exists for plantago psyllium with moderate evidence and chicory inulin.
Effect
Beneficial
Effect size
Moderate
Dose
30g of fiber per day
Plantain→Maintained Remission in Ulcerative Colitis
There is also an 'open recommendation' for curcumin for both, remission induction and maintenance.
Effect
Beneficial
Effect size
Moderate
Dose
30g of fiber per day
Turmeric→Induced Remission in Ulcerative Colitis
There is also an 'open recommendation' for curcumin for both, remission induction and maintenance.
Effect
Beneficial
Effect size
Moderate
Turmeric→Maintained Remission in Ulcerative Colitis
There is also an 'open recommendation' for curcumin for both, remission induction and maintenance.
Effect
Beneficial
Effect size
Moderate
Wormwood→Improved Crohn Disease Symptom
Some phytotherapeutic treatments (e.g., Artemisia absintium, Boswellia serata) show evidence of effectiveness for the treatment of Crohn's disease, but data are not yet sufficient for recommendations.
Effect
Beneficial
Effect size
Small