Menthacarin, a Proprietary Peppermint Oil and Caraway Oil Combination, Improves Multiple Complaints in Patients with Functional Gastrointestinal Disorders: A Systematic Review and Meta-Analysis.

INTRODUCTION: This systematic review summarizes published data on Menthacarin, the proprietary combination of peppermint oil and caraway oil, in the treatment of functional gastrointestinal disorders. Efficacy was assessed by meta-analysis of placebo-controlled trials. METHODS: We searched PubMed, the Cochrane Library, and the manufacturer's information system for clinical studies investigating the safety and efficacy of Menthacarin. Efficacy analyses included change from baseline of epigastric pain and general improvement of the patients' condition. RESULTS: Five randomized trials involving 580 patients were found, demonstrating significant effects of Menthacarin on symptoms of functional dyspepsia (FD) compared to placebo or similar effects compared to a reference drug. Seven other studies reported favorable results on therapeutic application in FD patients with concomitant Helicobacter pylori infection, in irritable bowel syndrome (IBS), and on tolerability in FD patients from 12 years of age. Three trials in FD with 249 patients were eligible for meta-analysis. Results demonstrate a significant reduction in pain intensity (standardized mean difference: 0.80; 95% confidence interval (CI): 0.39-1.21) and in item 2 of the Clinical Global Impression Scale (risk ratio: 2.65; 95% CI: 1.81-3.87) for Menthacarin. CONCLUSIONS: Menthacarin was shown to be effective and safe for the treatment of FD and represents a promising option for symptoms of IBS.

[Therapeutic management of irritable bowel syndrome in the family doctor's practice - probiotics and phytotherapeutics are often used successfully]. / Therapiemanagement des Reizdarmsyndroms in der Hausarztpraxis : Probiotika und Phytotherapeutika kommen häufig erfolgreich zum Einsatz.

BACKGROUND: Irritable bowel syndrome (RDS) is one of the most common functional disorders of the gastrointestinal tract in primary care. As pathophysiology is still insufficiently understood and there is no causal therapeutic approach, therapy is still a challenge in daily practice. METHOD: As part of a nationwide survey in written form, primary care physicians (general practitioners and internists) were contacted by postal service and asked to complete a questionnaire on RDS. The focus was on the therapeutic management of RDS patients and personal experience with the various drug therapy options. RESULTS: A total of 487 doctors from all federal states participated in this survey. According to the doctors, more than 70% of RDS patients present with multiple symptoms and report a severe to very severe reduction in quality of life (78%). Doctors considered stress (76%), a change in the intestinal microbiome (56%), poor nutrition (35%) and visceral hypersensitivity (26%) to be the main causes of RDS. The drugs most commonly recommended by the specialist were antispasmodics (44%), phytotherapeutics (38%) and probiotics (37%). In contrast, only 54% of the GPs surveyed were satisfied with the success of spasmolytic therapy, but 75% were satisfied with phytotherapeutic agents and probiotics. More than 60% of the respondents were dissatisfied with tricyclic antidepressants. The high consultation intensity (72%) and expectations of the patients (73%) as well as their changing symptoms (49%) were identified by the doctors as the greatest challenges in daily practice. CONCLUSION: Probiotics and phytotherapeutics are often a successful option for treating patients with irritable bowel syndrome in primary care.

[Peptic enzymes for irritable stomache syndrome: a new, old therapeutic option? Results of a survey among family doctors]. / Verdauungsenzyme beim Reizmagensyndrom: eine neue alte Therapieoption? : Ergebnisse einer Hausarztbefragung.

OBJECTIVE AND METHOD: The treatment of patients with functional dyspepsia (irritable stomache syndrome) was recorded in a nationwide survey among family doctors. On a questionnaire, the physicians should provide information on the use of a combination preparation of gastric enzyme (pepsin) and amino acids, duration of use, therapy success and patients' contentment. RESULTS: A total of 874 family doctors were contacted, 201 questionnaires were completed and evaluated. The physicians administered the combination preparation predominantly for feeling of fullness and pressure (82%), flatulence (78%) and upper abdominal pain (57%), usually over 3-6 weeks. They confirmed, that patients who suffered from these symptoms were very content with the combination preparation. 85% of the doctors rated the therapeutic success as "good" to "very good". CONCLUSION: The combination of gastric enzyme (pepsin) and amino acids can be an effective therapeutic option for functional dyspepsia (irritable stomache syndrome) in medical practice.

NSAID-associated dyspepsia and ulcers: a prospective cohort study in primary care.

BACKGROUND AND AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs) cause dyspeptic complaints and lesions in the upper gastrointestinal tract. The true incidence of these side effects in the everyday situation remains uncertain. We therefore investigated as to how often patients on NSAIDs in the primary care setting must be expected to develop troublesome dyspepsia and/or ulcers in the upper gastrointestinal tract. PATIENTS AND METHODS: Admitted to the study were consecutive patients requiring NSAID treatment for at least 2 weeks, who were free of treatment-requiring dyspeptic symptoms, and who were not receiving any prophylactic co-medication. After a minimum of 2 weeks of treatment with a NSAID, a standardized questionnaire and endoscopy of the upper gastrointestinal tract were obtained. RESULTS: 104 patients (median age 53 years, 91 women) were recruited to the study. Four patients had to be excluded for protocol violations. NSAID treatment was applied mainly with diclofenac (n = 67), followed by ibuprofen (n = 22) and rofecoxib (n = 9). The main indication was degenerative complaints affecting the vertebral column and joints. Under treatment, 35% of the patients developed troublesome dyspepsia that required treatment. The frequency of dyspepsia was independent of the duration of NSAID use. Ulcer prevalence was 16% (duodenal ulcer: n = 5; gastric ulcer: n = 11; cardiac ulcer: n = 1). Relevant epigastric pain was experienced more frequently by ulcer patients than those with no ulcer (35 vs. 18%, p = n.s.), but their overall symptom frequency was no higher than in the latter. Predictors for the development of ulcer were smoking (odds ratio 5.11 [1.59-16.48]), regular use of alcohol (odds ratio 4.49 [1.34-15.07]) and duration of treatment less than 1 month (odds ratio 4.95 [1.06-23.09]). No ulcer complications occurred during the period under observation. Overall, 44% of the patients developed troublesome dyspepsia and/or ulcer. CONCLUSION: Primary care patients with an average risk profile frequently develop dyspeptic symptoms requiring treatment, and ulcers while on NSAIDs. Patients who developed an ulcer were not identifiable on the basis of symptoms or risk factors.