Pain in the upper abdomen that is worse before meals and during the night might be due to a peptic ulcer. The major cause of ulcers is an infection of the stomach by the bacterium Helicobacter pylori...

Alternative Rx for IBS

Peppermint oil has a long history of use for abdominal pain
Peppermint oil

Alternative treatment is a term that can cover a wide range of options.


  • Complementary medicine is perhaps a better term.
  • There is no doubt that alternative treatments are popular for gastrointestinal complaints - partly because of dissatisfaction with "traditional" or scientific medicine.
  • Most comments refer to treatment of irritable bowel syndrome.


Prebiotics and functional foods.


  • This is the concept that dietary changes can alter the type of bacteria in the colon or that certain by-products of bacterial metabolism may be helpful.
  • The type and number of bacteria in the gut can be influenced by diet but there are still no clear recommendations in this area.
  • Resistant starch is metabolized to produce butyrate which is a "fuel" for intestinal cells.
  • One formulation is wheat dextran (marketed as Benefibre)
  • There is no evidence that this approach is helpful. One problem is the production of "wind" by bacterial fermentation which is likely to aggravate irritable bowel.
  • Inulin is promoted as a useful prebiotic  -  the value of this additive is still unclear


Digestive Enzyme Supplements


  • These products usually contain pancreatic enzymes as the main active ingredients.
  •  A deficiency of pancreatic enzymes is a very rare problem - the body makes enzymes much in excess of requirements.
  • There is no suggestion of any problem with the digestion and absorption of nutrients with irritable syndrome. Therefore there is NO rationale for the use of these supplements but a few people with IBS do seem to have some benefit (this could just be a placebo response)

Fish Oil and Omega-3 Supplements


  • There is some evidence for an anti-inflammatory effect of these supplements.
  • Irritable bowel is not an inflammatory disorder therefore no benefit would be expected but there could be an effect for colitis.  Controlled studies have been equivocal  - some showing a positive effect; others showing no effect compared to placebo

Peppermint Oil


  • Peppermint may have an anti-spasmodic effect on the colon - reducing lower abdominal cramping pain in irritable bowel syndrome. 
  • Peppermint also relaxes the valve at the lower end of the oesophagus and can aggravate reflux (heartburn). This is why peppermint is given out at the end of a meal in restaurants - to encourage belching and ease any pressure in the stomach - but potentially will also allow reflux of the meal (and acid).
  • To reduce this effect on the oesophagus, peppermint oil is given as an enteric-coated capsules that releases the peppermint in the small bowel and colon. This is available as Colpermin (also Mintec). It is available directly from chemists and is not funded.
  • There have been a several clinical trials showing a benefit in IBS particularly for relief of pain (presumably as the result of colonic spasm).
  • I suspect that most pain from IBS is not spasm but distension of an over-sensitive colon with wind therefore this approach will have only limited success. Overall the effects of peppermint are disappointing in my experience.  It is worth trying peppermint tea (certainly as a good substitute for coffee).  The success of the FODMAP diet in reducing pain from IBS suggest that reducing wind and therefore distension of the bowel is the main way to relieve pain

Chinese Herbal Remedies


  • There is beginning to be some formal evaluation of several traditional herbal approaches to IBS. To date the trials have been negative or disappointing but further work is being done.
  • Combination Chinese herbal treatments include ingredients such as barley, cardomen, licorice, rhubarb. Ginger may be given alone - minimal studies done - may decrease nausea.

Naturopathy


  • These therapists have a good record in treating bowel symptoms from IBS and have a variety of approaches to the symptoms.  A wheat-free and diary-free diet is commonly recommended.
  •  These dietary exclusions are often effective as discussed in the IBS and diet section.  Other natural treatments as discussed above are given in combination sometimes with success.


Hypnotherapy and counselling


  • Several good studies in irritable bowel have shown that hypnotherapy is effective. This is not widely available and I have no direct experience of any beneficial results. These studies do emphasize the complex connections between mind and gut.
  • Published data suggests an 80% improvement rate (well above any other treatment - conventional or alternative) - and this effect lasts for 6 months or more after treatment completed. It does require weekly therapy over several months (high cost) and is dependent on the therapist - not many have experience in treatment of IBS.
  • There is evidence that cognitive behavioural therapy can work. This is a form of counselling (actually the most widely practiced) that concentrated on coping mechanisms.  There is even a web-based program being developed.  Would certainly be a lot cheaper. 
  • This illustrates the need to consider treatment at all levels  (from the lining of the gut to the brain).  The way we process signals from the gut is affected by stress and by our learned coping mechanisms.  We learn by our life experience some unhelpful strategies such as internalising stress as a bodily symptom  - approaches that need to be unlearnt or adjusted. 

Acupuncture


  • This has been studied in a randomised trial and a benefit was shown. This treatment may have most value if pain is the predominant symptom.
  •  Also used to treat bloating, nausea - difficult to see how this should work. Small clinical studies show contradictory results.


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