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Systematic review and meta-analysis: efficacy of peppermint oil in irritable bowel syndrome.

  • 2022-08-09
  • Alimentary pharmacology & therapeutics 56(6)
    • Maria Rosa Ingrosso
    • Gianluca Ianiro
    • Judy Nee
    • Anthony J Lembo
    • Paul Moayyedi
    • Christopher J Black
    • Alexander C Ford

Study Design

Type
Meta-Analysis
Sample size
n = 1,030
Population
1030 patients with IBS from 10 RCTs
Methods
Meta-analysis of RCTs; searched literature up to 2nd April 2022; data pooled using random effects model
  • Rigorous Journal

Background

Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction, with a complex pathophysiology. Antispasmodics are prescribed as first-line therapy because of their action on gut dysmotility. In this regard, peppermint oil also has antispasmodic properties.

Aim

To update our previous meta-analysis to assess efficacy and safety of peppermint oil, particularly as recent studies have cast doubt on its role in the treatment of IBS METHODS: We searched the medical literature up to 2nd April 2022 to identify randomised controlled trials (RCTs) of peppermint oil in IBS. Efficacy and safety were judged using dichotomous assessments of effect on global IBS symptoms or abdominal pain, and occurrence of any adverse event or of gastro-oesophageal reflux. Data were pooled using a random effects model, with efficacy and safety reported as pooled relative risks (RRs) with 95% confidence intervals (CIs).

Results

We identified 10 eligible RCTs (1030 patients). Peppermint oil was more efficacious than placebo for global IBS symptoms (RR of not improving = 0.65; 95% CI 0.43-0.98, number needed to treat [NNT] = 4; 95% CI 2.5-71), and abdominal pain (RR of abdominal pain not improving = 0.76; 95% CI 0.62-0.93, NNT = 7; 95% CI 4-24). Adverse event rates were significantly higher with peppermint oil (RR of any adverse event = 1.57; 95% CI 1.04-2.37).

Conclusions

Peppermint oil was superior to placebo for the treatment of IBS, but adverse events were more frequent, and quality of evidence was very low. Adequately powered RCTs of peppermint oil as first-line treatment for IBS are needed.

Research Insights

  • Peppermint→Improved Irritable Bowel Syndrome Symptoms

    Peppermint oil was more efficacious than placebo for global IBS symptoms (RR of not improving = 0.65; 95% CI 0.43-0.98, number needed to treat [NNT] = 4; 95% CI 2.5-71)

    Effect
    Beneficial
    Effect size
    Moderate
  • Peppermint→Reduced Abdominal Pain

    Peppermint oil was more efficacious than placebo for abdominal pain (RR of abdominal pain not improving = 0.76; 95% CI 0.62-0.93, NNT = 7; 95% CI 4-24)

    Effect
    Beneficial
    Effect size
    Moderate

Adverse Events Reported

  • Peppermint→Overall tolerability

    Adverse event rates were significantly higher with peppermint oil (RR of any adverse event = 1.57; 95% CI 1.04-2.37).

    Finding
    Increased risk
    Magnitude
    RR of any adverse event = 1.57; 95% CI 1.04-2.37
    Significant
    Yes
  • Peppermint→gastro-oesophageal reflux

    occurrence of any adverse event or of gastro-oesophageal reflux.

    Finding
    Reported
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