Abstract
The pathophysiology of functional gastrointestinal disorders (FGIDs) is still unclear and various complex mechanisms have been suggested to be involved. In many cases, improvement of symptoms and quality of life (QoL) in patients with FGIDs is difficult to achieve with the single-targeted treatments alone and clinical application of these treatments can be challenging owing to the side effects. Herbal preparations as complementary and alternative medicine can control multiple treatment targets of FGIDs simultaneously and relatively safely. To date, many herbal ingredients and combination preparations have been proposed across different countries and together with a variety of traditional medicine. Among the herbal therapies that are comparatively considered to have an evidence base are iberogast (STW-5) and peppermint oil, which have been mainly studied and used in Europe, and rikkunshito and motilitone (DA-9701), which are extracted from natural substances in traditional medicine, are the focus of this review. These herbal medications have multi-target pharmacology similar to the etiology of FGIDs, such as altered intestinal sensory and motor function, inflammation, neurohormonal abnormality, and have displayed comparable efficacy and safety in controlled trials. To achieve the treatment goal of refractory FGIDs, extensive and high quality studies on the pharmacological mechanisms and clinical effects of these herbal medications as well as efforts to develop new promising herbal compounds are required.
Highlights
Functional gastrointestinal disorders (FGIDs) are a group of diseases with variable combinations of chronic or recurrent gastrointestinal (GI) symptoms not explained by structural or biochemical abnormalities [1]
FGIDs include diseases that are commonly found in daily practice, such as gastroesophageal reflux disease (GERD), functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC), and show various symptom presentation throughout the GI tract
STW-5 normalizes the stomach and intestinal motility and reduces inflammation and gastric acid production. These effects partially influence the pathophysiology of the FGIDs and their therapeutic effects have been proven in several clinical studies
Summary
Functional gastrointestinal disorders (FGIDs) are a group of diseases with variable combinations of chronic or recurrent gastrointestinal (GI) symptoms not explained by structural or biochemical abnormalities [1]. FGIDs include diseases that are commonly found in daily practice, such as gastroesophageal reflux disease (GERD), functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC), and show various symptom presentation throughout the GI tract They impair the quality of life (QoL) of patients and entail a huge expenditure of medical resources [2, 3]. The possible pathological mechanisms involved in these diseases have been studied and proposed from various perspectives, their etiologies are still not fully understood. Numerous factors such as GI dysmotility, visceral hypersensitivity, altered immune function, stress, central nervous system dysregulation, intestinal dysbiosis, and genetic predispositions seem to affect the clinical expressions of these diseases, but the mechanisms or complex crosstalk between the pathways have not been clearly elucidated [4]. Despite the advances on the understanding of the pathophysiology of FGIDs and the development of drugs targeting novel pathways, agents that display satisfactory therapeutic effects on various FGIDs according to both patients and physicians are still limited [5]
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