1 2
Dr.SuparyaSubashP,Dr.PVGiri
1 rd3 yearPGScholar,DepartmentofKayachikitsa,VaidyaratnamAyurvedaCollege.
2MD(Ayu),Ph.D.,MHA,Professor,DepartmentofKayachikitsa,VaidyaratnamAyurvedaCollege.
ABSTRACT
Definition of Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by altered bowel habits and pain or discomfort in the abdomen without detectable structural abnormalities. In IBS severity of symptoms varies and can significantly impair quality of life, resulting in high health care costs.This study systematicallyreviewedthepublishedclinicalresearchinPubMedonAyurvedicmedicinesandtheirreliablemechanismsofactionincontrollingIBS.Ratherthe combinations of single-drug formulations mentioned in our classical textbooks may be more effective.And different clinicaltrials must be needed to evaluatethe effectsofAyurvedicpreparationsonIBS.
KEYWORDS:AyurvedicSingleDrugs,AyurvedicFormulations,IrritableBowelSyndrome.
1.INTRODUCTION:
1.1.Background:
Irritablebowelsyndrome(IBS)isinterpretedasafunctionalboweldisordercharacterizedbyalteredbowelhabitsandpainordiscomfortintheabdomeninthe absenceofdetectablestructuralabnormalities;Throughouttheworld,about10 to20%ofadultsandadolescentshavesymptomsconsistentwithIBS;Mostof the IBS patients have their first symptoms before age 45 but it affects all ages; WomenareidentifiedwithIBStwotothreetimesasoftenasmenandmakeup (1) 80%ofthepopulationwithsevereIBS'
1.2.Statementoftheproblem:
InIBSseverityofsymptomsvariesandcansignificantlyimpairqualityoflife, resultinginhighhealthcarecosts.Duetodissatisfyingresultswithconventional IBStreatments,complementaryandalternativemedicines(CAM)arebecoming attractiveoptionsformanypatients;OfthevariousCAMinterventions,theTraditional Indian Medicine Ayurveda, a Whole Medical System, is increasingly usedworldwideandisrecognizedbytheWorldHealthOrganizationasmedical science;AnexpandingnumberofIBSpatientsarebeginningtoreceiveCAMin (2) theworld,Themostfrequentlyusedareherbalremedies(43%)
1.3.Objectiveofresearch:
This study aimed to systematically review the published clinical research in PubMedonAyurvedicmedicinesandtheirreliablemechanismsofactionincontrollingIBS.
2.MATERIALANDMETHODS:
2.1.Searcheddatabases:
Ayurvedicmedicine'sefficacyinthemanagementofIBShasbeenevaluated.For this purpose, electronic databases, including PubMed, were searched to obtain studies giving human evidence of the efficacy ofAyurvedic drugs in the treatment of IBS. Collected data were for the years 2001 to 2021 (up to July). The searchtermswere:"herbaldrugsandIBS","AyurvedaandIBS",or"Ayurvedic drugsandIBS",and"AyurvedicformulationandIBS".Alsoreviewedthereferencelistsofretrievedarticlesforadditionalapplicablestudies.
2.2.
Inclusionandexclusioncriteria:
Each article's title and abstract were examined. Studies assessing CAM other thanAyurvedicdrugsandformulations,duplicates,reviews,andstudiesinvestigatinggastrointestinaldiseasesotherthanIBSwereexcluded.
2.3.
Qualityassessment:
Analysis and quality evaluation of the literature was performed. Out of 161 records found in the PubMed databases; 9 related studies were included in the finalanalysis(Figure1).ThisreviewhasfocusedonthesingleAyurvedicdrugs inIBStreatment,suchasAloevera,Curcumalonga,Ginger,andcombinations.
3.RESULTSANDDISCUSSION:
3.1Ginger:
Thestudywasarandomized,controlled,parallel-groupdesigninwhich15participantswererandomlyallocatedtoeachofthreearms:Placebo,onegramgingerdaily,ortwogramsgingerdaily Thedurationoftreatmentwas28days;Asignificant reduction in symptoms by 34.8% and 26.4%, respectively seen in Placebo and 1 gram ginger groups. Several treatment responders between groups were not different (57.1% placebo, 46.7% 1 gr ginger, 33.3% 2 grams ginger; p>.05);AdequatereliefwasreportedinthePlacebogroup,andboththeginger groupswereequal,anditis53.3%(p>.05);Thisdouble-blind,randomizedcontrolledpilotstudyproposesgingeriswelltoleratedbutdidnotexecutebetterthan (2)Placebo Otherstudiesrelievetheimportanceofgingerinintestinalhypersensitivity of diarrhoea-predominant irritable bowel syndrome by inhibiting pro(3) inflammatoryreactions GingerhasAgniDepanaandPachanaproperties,and itiswellrepresentedintheformulationsthathaveactionin Koshtasritha Rogas. ItshowstheimportanceofgingerinIBS-likediseases.Buttheresultsmayvary with the medium of usage, combination of drugs, stage of disease, and insufficientsamplesize.
3.2
AloeVera:
ThestudydesignofAloeveraismulticentre,randomized,double-blind,crossover placebo-controlled; Participants were randomized to Aloe vera, washout, placebo or placebo, washout, Aloe vera; Each 60 mLof preparation was taken twiceaday,orally UsingtheGastrointestinalSymptomsRatingScore,Irritable Bowel Syndrome Quality of Life and EuroQol patient quality of life was measured;Only47completedallquestionnaires,andbothstudyarmsoutofrandom-
(6)
ized110patients.Intermsofqualityoflife,nodifferencebetweentheplacebo andAloeveratreatmentshowsinstatisticalanalysis;Thisstudywasincapableof showingthatAloeverawassuperiortoplaceboinimprovingqualityoflife;the Powerofthestudytodetectaclinicallyimportantdifferencemayhaveimpacted (4) duetodropoutsandotherconfoundingfactors
AnotherstudydesignforAloeverawasdouble‐blind,placebo‐RCT;Symptoms ofIBSwereassessedatbaseline,1and3months;Fifty-eightpatientswererandomized,49completedtheprotocolfor1monthand41to3months;Elevenof thirty-one(35%)Aloeveraparticipants,and6of27(22%)placeboparticipants respondedat1month(p=0.763);Diarrhoeapredominantparticipantsshoweda trendtowardsaresponsetotreatmentat1month(10/23V2/14,p=0.07);The studysaysthattherewasnoproofthatAloeverabenefitspatientswithIBS;However,thestudyalsostatesthatwecouldnotruleoutthepossibilitythatimprovementhappenedinpatientswithdiarrhoeaoralternatingIBSwhilsttakingAloe vera; Further investigations are necessary for patients with diarrhoea(5) predominantIBS,inalesscomplexgroupofpatients
3.3Curcumalonga:
Apartiallyblinded,randomized,two-doseapilotstudywascarriedouttoassess theeffectsofCurcumalongaonirritablebowelsyndrome;FivehundredparticipantswerescreenedforIBSusingtheRomeIIcriteria;Twohundredandseven suitableparticipantswererandomized;Standardizedturmericextractcontaining oneortwotabletstakendailyfor8weeks;Irritablebowelsyndromeprevalence decreasedsignificantlybetweenscreeningandbaselineat41%and57%respectivelyinbothgroups,withafurthersignificantdropof53%and60%intheoneand two-tablet groups respectively between baseline and after treatment (p < 0.001). Abdominal pain/discomfort scores reduced significantly by 22% and 25% in the one- and two-tablet groups, respectively, as revealed in post-study analysis,thedifferencetendingtowardsignificance(p=0.071).TherewassignificantprogressinallbaroneoftheIBSQOLscalesofbetween5%and36%in both groups. Approximately two-thirds of all participants reported improved symptomsaftertreatment,andtherewasafavourableshiftinself-reportedbowel
patterns.Thisstudyshowsnosignificantdifferencesbetweengroups
3.4
Menthapiperita:
Inadouble-blindstudy,fifty-sevenpatientswithirritablebowelsyndromewere treatedwithpeppermintoil,i.e.,twoenteric-coatedcapsulestwiceperdayorplacebofor4weeks.Symptomswereassessedbeforetherapy,afterthefirst4weeks of treatment, and 4 weeks after the end of treatment. The symptoms evaluated were: abdominal pain or discomfort, abdominal bloating, constipation, diarrhoea,thefeelingofincompleteevacuation,thepassageofgasormucus,painat defecation,andurgencyatdefecation.Afterthefirst4weeksoftreatment,compared with 38% in the placebo group (P<0.009), 75% of the participants in the peppermint oil group showed a >50% reduction of basal (before therapy) total irritablebowelsyndromesymptomsscore.Withpeppermintoilafterthefirst4 weeksoftreatmentandat4weeksaftertheendofthetreatmentcomparedwith beforetreatment,foundastatisticallysignificantreductionofthetotalirritable bowelsyndromesymptomsscorebeforetreatment:2.19+/-0.13,afterthefirst4 weeksoftherapy:1.07+/-0.10*,4weeksaftertheendoftherapy:1.60+/-0.10*, *P<0.01 compared with before treatment, mean+/-S.E.M.), while found no changewiththeplacebo.Thestudyconcludedthat4weeksoftreatmentwithpeppermintoilimprovesabdominalsymptomsinpatientswithirritablebowelsyn(7)drome
Another study was a randomized, double-blind placebo-controlled study conducted on 90 participants; Participants took one capsule of enteric-coated, delayed-releasepeppermintoilorplacebothreetimesdailyfor8weeks;Evaluatedtheirsymptomsandqualityoflifeafterthefirst,fourth,andeighthweeks; The number of participants free from abdominal discomfort or pain changed from0atweek0to14atweek8inthepeppermintoilgroupandfrom0to6incontrols (P< 0.001);As compared to controls the severity of abdominal pain was alsoreducedsignificantlyinthepeppermintoilgroup.Furthermore,peppermint oil significantly improved the quality of life;There was no significant adverse reaction;StudyconcludedthatPeppermintoilissafeandeffectiveasatherapeu(8) ticagentinparticipantswithIBSsufferingfromabdominalpainordiscomfort
3.5BilvadiLeha:
Anopen-label,singlegroup,andnon-controlledclinicaltrialarecarriedoutwith BilvadiLeha;Inthisclinicaltrial,51participantswithIBShaveregistered,outof which 46 participants completed the treatment; Duration of administration of Bilvadi Leha was 12 weeks; Out of 46 participants, found positive response to therapy in 37 (80.43%) participants, 7 (15.21%) participants showed partial responsetotreatmentand2(4.34%)participantsreportednoreactiontothemedicine;ThestudyshowsstatisticallysignificantimprovementintheIBSseverity scoreaswellasalltheclinicalfeaturesofIBS;Therewasnoadversedrugreactionperceivedduringtheperiodoftrial;Furtherstudieswithlargersamplesize should be carried out in different places with a standard control drug to obtain (9) moreinputtheactionofthisnoveldrugcompoundinmanagementIBS
3.6Murrayakoenigii,PunicagranatumandCurcumalonga:
Punica granatum (pomegranate), Murraya koenigii (curry),andCurcumalonga (turmeric)areusedtomakeAyurvedicherbalcompound,anditiscomparedtoa placebo in participants with diarrhoea-predominant IBS. This study was conducted as a randomized placebo-controlled crossover trial with a randomized sequenceofmedicineandplaceboforeachparticipant.Participantsandoutcome assessorswereblinded.Participantswereadvisedtoingestthedecoctiontwice daily for 4 weeks. IBS symptom intensity was the primary outcome measure; Includingqualityoflife,anxiety,depression,compliance,andsafetyinthesecondary outcomes. The trial included 32 IBS participants. Eleven participants droppedoutduringthetrialresultingin37completingthetreatmentand35completing placebos. No group differences were found in IBS symptom intensity betweenAyurvedic herbal medicine and placebo (difference 24.10; 95% CI:17.12;65.32,p=0.26).Thesameappliedtosecondaryoutcomes.Thestudyconcludedthat Punicagranatum,Murrayakoenigii,andCurcumalongacontaining Ayurvedicherbalpreparationappearedtobenomoreeffectiveinimprovingdiar(10) rhoea-predominantirritablebowelsymptomsthanaplacebo
3 7 Ayurvedic vs Conventional Nutritional Therapy Including LowFODMAPDiet for Patients with Irritable Bowel Syndrome—ARandomizedControlledTrial:
TocomparetheeffectsofconventionalandAyurvedicnutritionaltherapyinparticipantswithirritablebowelsyndrome(IBS);Sixty-nineparticipantswithIBS were randomized to Ayurvedic (n = 35) or conventional nutritional therapy according to the recommendations of the German Nutrition Society, including thelow-FODMAPdiet(n=34);Trialvisitstookplacebeforeinterventionand after1,3,and6months;After3months,estimatedmarginalmeansforIBS-SSS reductionswere72.7(95%CI=38.8-106.7;p<0.001)intheconventionalgroup and 123.8 [95% confidence interval (95% CI) = 92.8-154.9; p < 0.001] in the Ayurvedic group; Compared to the conventional therapy group, the IBS-SSS reduction was significantly higher in theAyurveda group (estimated marginal mean=51.1;95%CI=3.8-98.5;p=0.035)andclinicallymeaningful;After3 months, sixty-eight percentage of the variance in IBS-SSS reduction can be explained by treatment, 6.5% by patients' expectations for their therapies, and 23.4%byIBS-SSSatpre-intervention;Boththerapiesareequivalentintheircontributiontotheoutcomevariance.Herenosignificantgroupdifferencesinany secondaryoutcomemeasures;ThestudyconcludedthatIBSparticipantsseemto benefit significantly from Ayurvedic or conventional nutritional therapy; The results permit further studies with larger sample sizes and longer-term follow(11) ups
4.CONCLUSION:
ThisreviewevaluatedvariousAyurvedicdrugs,preparations,andpossiblemechanisms to treat IBS. In IBS, Mentha piperita plays a vital role in controlling abdominalpain.Aloevera,ginger,andCurcumadisplaydifferentmechanisms such as prosecretory activity, anti-inflammatory activity, and normalising gastrointestinal motility in IBS management. Bivadi Leha shows improvement in IBS symptoms According to numerous parameters that effect the pathophysiology of IBS, it is believed thatAyurvedic formulations containing severaldrugscanbemorebeneficialthansingledrugs.Atthesametime,single
drug studies mislead the scientific community that theAyurvedic drugs do not have a role in controlling IBS symptoms. Acharyas' concept of combining ayurvedicdrugsandmakingaformulationforadiseaseisnotnearlylikemixing 2or3drugs.BasedonmanycriterialikeRasapanchaka,itisassigned.Sosuch combinationofdrugsnotmentionedinAyurvedaclassicaltextbooksusedinthe nameofAyurvedicherbswillalsomisleadthescientificfraternity However,differentclinicaltrialsmustbeneededtoevaluatetheeffectsofAyurvedicpreparations on IBS. Black box design may be more helpful in theAyurvedic field as Ayurvedaisanindividualisticmedicine.
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