Anna K. Koch

Herbal Medicines for Gastrointestinal Disorders in Children and Adolescents: A Systematic Review

This is the first review that systematically summarizes effectiveness and safety of herbal medicines for gastrointestinal disorders in children and adolescents exclusively. CONTEXT: Gastrointestinal disorders are common childhood complaints. Particular types of complementary and alternative medicine, such as herbal medicine, are commonly used among children. Research information on efficacy, safety, or dosage forms is still lacking. OBJECTIVES: To systematically summarize effectiveness and safety of different herbal treatment options for gastrointestinal disorders in children. DATA SOURCES: Medline/PubMed, Scopus, and the Cochrane Library were searched through July 15, 2016. STUDY SELECTION: Randomized controlled trials comparing herbal therapy with no treatment, placebo, or any pharmaceutical medication in children and adolescents (aged 0–18 years) with gastrointestinal disorders were eligible. DATA EXTRACTION: Two authors extracted data on study design, patients, interventions, control interventions, results, adverse events, and risk of bias. RESULTS: Fourteen trials with 1927 participants suffering from different acute and functional gastrointestinal disorders were included in this review. Promising evidence for effectiveness was found for Potentilla erecta, carob bean juice, and an herbal compound preparation including Matricaria chamomilla in treating diarrhea. Moreover, evidence was found for peppermint oil in decreasing duration, frequency, and severity of pain in children suffering from undifferentiated functional abdominal pain. Furthermore, evidence for effectiveness was found for different fennel preparations (eg, oil, tea, herbal compound) in treating children with infantile colic. No serious adverse events were reported. LIMITATIONS: Few studies on specific indications, single herbs, or herbal preparations could be identified. CONCLUSIONS: Because of the limited number of studies, results have to be interpreted carefully. To underpin evidence outlined in this review, more rigorous clinical trials are needed.

Complementary and Integrative Gastroenterology

Complementary and integrative medicine is developing within gastroenterology, expanding options particularly for inflammatory bowel disease, irritable bowel syndrome, and reflux esophagitis. This article encompasses new developments in complementary integrative medicine with an emphasis on herbal therapies. Studies of potential therapies have been advancing with increasing sophistication. The best studied with the most promising results in ulcerative colitis is the use of curcumin both for the induction and maintenance of remission. Other polyphenols, such as resveratrol and epigallocatechin-3-gallate, also have supportive data for ulcerative colitis. Mind-body approaches have been applied in these diseases with positive data, particularly for irritable bowel syndrome.

The effects of yoga and self-esteem on menopausal symptoms and quality of life in breast cancer survivors—A secondary analysis of a randomized controlled trial

OBJECTIVES Previous research has found that yoga can enhance quality of life and ease menopausal symptoms of breast cancer survivors. The study examined whether self-esteem mediated the effects of yoga on quality of life, fatigue and menopausal symptoms, utilizing validated outcome measures. STUDY DESIGN This is a secondary analysis of a randomized controlled trial comparing the effects of yoga with those of usual care in 40 breast cancer survivors who suffered from menopausal symptoms. All participants completed all 3 assessments (week 0, week 12, and week 24) and provided full data. MAIN OUTCOME MEASURES Outcomes were measured using self-rating instruments. Mediation analyses were performed using SPSS. RESULTS Self-esteem mediated the effect of yoga on total menopausal symptoms (B=-2.11, 95% BCI [-5.40 to -0.37]), psychological menopausal symptoms (B=-0.94, 95% BCI [-2.30 to -0.01]), and urogenital menopausal symptoms (B=-0.66, 95% BCI [-1.65 to -0.15]), quality of life (B=8.04, 95% BCI [3.15-17.03]), social well-being (B=1.80, 95% BCI [0.54-4.21]), emotional well-being (B=1.62, 95% BCI [0.70-3.34]), functional well-being (B=1.84, 95% BCI [0.59-4.13]), and fatigue (B=4.34, 95% BCI [1.28-9.55]). Self-esteem had no effect on somatovegetative menopausal symptoms (B=-0.50, 95% BCI n.s.) or on physical well-being (B=0.79, 95% BCI n.s.). CONCLUSIONS Findings support the assumption that self-esteem plays a vital role in the beneficial effect of yoga and that yoga can have long-term benefits for women diagnosed with breast cancer and undergoing menopausal transition.

A Systematic Review of Phytotherapy for Acute Rhinosinusitis

Herbal medicine is a promising alternative in the treatment of acute rhinosinusitis (ARS). We performed a systematic review for phytopharmaceutical treatments of ARS. A computerized search of databases (Cochrane Library, PubMed, and Scopus) up to 16 September 2015 was performed. Randomized controlled trials (RCTs) and controlled trials (CTs) were included and assessed using the Cochrane risk of bias tool. Seven trials on Pelargonium sidoides (EPs 7630, Umckaloabo®), Myrtol (GeloMyrtol® forte), BNO 1016 (Sinupret® extract), BNO 101 (Sinupret®), Cyclamen europaeum (Nasodren®), and Esberitox® were included. Risk of bias was heterogeneous. EPs 7630 appeared to be useful in the treatment of ARS. Myrtol showed benefits against a placebo compound, and BNO 1016 and BNO 101 might be helpful; however, there was little evidence for the effectiveness of Cyclamen europaeum and Esberitox®. Herbal medicine might be effective for the treatment of ARS, but given the low number of clinical trials and the heterogeneous methodological quality, further research is necessary.

Entwicklungen in der Gastroenterologie

Integrative Gastroenterologie Die moderne Gastroenterologie steckt in einem Dilemma. Große Erfolge werden mit der Entwicklung moderner und technisierter diagnostischer Verfahren erzielt. In der Therapie kommt die moderne Pharmakotherapie, ein Milliardenmarkt in Deutschland, aber gerade bei chronischen gastroenterologischen Erkrankungen häufig nicht zu einem zufriedenstellenden Ergebnis für den einzelnen Patienten. Am Beispiel der Biologika in der Therapie chronisch entzündlicher Darmerkrankungen kann man verfolgen, dass trotz hoher Kosten ausreichende Therapieerfolge häufig ausbleiben, dass sich in vielen Fällen aber relevante Nebenwirkungen einstellen.

The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption

Background: Fructose malabsorption is commonly diagnosed by the hydrogen fructose (H2) breath test. However, the mechanisms behind fructose malabsorption in humans are not well understood and the clinical relevance of this test is considered controversial. Hence, the main aim of this study is to evaluate the predictive value of the H2 breath test. Methods: Regarding exclusion criteria, the study enrolled 562 consecutive patients, enlisted to a gastroenterology clinic between 2009 and 2011 for testing malabsorption. In the final data analysis, 246 patients were included. Ecotrophologists used 3 categories to rate dietary success: complete response, partial response and no response to the diet. They also rated the occurrence of abdominal pain, diarrhoea and bloating during the H2 breath test. Ordinal regression analysis using SPSS was performed to evaluate whether H2 breath test results – measured as the maximum H2 level, the maximum increase in H2, and the area under the curve (AUC) – predicted dietary success or failure. Correlation analyses were applied to test whether symptoms of fructose malabsorption correlated with the H2 breath test measures. Finally, we evaluated whether cut-off-values of 40 or 60 parts per million (ppm) serve better than the test measure of 20 ppm to diagnose fructose malabsorption. Results: When a fructose-free diet was administered it was found that 103 patients (41.9%) were complete responders, 116 (47.2%) were partial responders and 27 (11%) were non-responders. The H2 breath test with the 20 ppm cut-off-value, that is, the maximum H2 level, the maximum increase in H2, and the AUC did not predict dietary response (all 95% CI ns). This was also the case when using 40 or 60 ppm as cut-off-values (all 95% CI ns). Abdominal pain during the test correlated significantly with the AUC. Diarrhoea and bloating correlated significantly with the AUC, the maximum H2 level and the maximum increase in H2 (p < 0.05). Conclusions: The H2 breath test produced no predictive value for the fructose-free diet outcomes; its value as a predictive test is therefore questionable. However, the symptoms of fructose malabsorption correlated significantly with the H2 breath test measures, and this is an indication that there is at least a degree of validity of the H2 breath test beyond the simple detection or exclusion of fructose malabsorption.

Komplementäre Therapieverfahren in der aktualisierten AWMF-S3-Leitlinie «Diagnostik und Therapie der Colitis ulcerosa»: Der Stellenwert von Therapieansätzen aus dem komplementären Bereich nimmt weiter zu

Die aktualisierte Version der Leitlinie «Diagnostik und Therapie der Colitis ulcerosa» wurde im Mai 2018 unter der Federführung der Deutschen Gesellschaft für Verdauungsund Stoffwechselkrankheiten (DGVS) veröffentlicht [1] . Sie wird bis zum 15. Mai 2022 gültig sein. Bereits die Vorgängerversion machte die Relevanz naturheilkundlicher und komplementärmedizinischer Verfahren bei der Behandlung von Patienten mit Colitis ulcerosa deutlich. Die Leitlinie enthielt für eine Reihe komplementärmedizinischer Therapieverfahren evidenzbasierte Empfehlungen [2] , etwa für die Phytotherapeutika Plantago ovata und Curcumin, für Akupunktur in Kombination mit Moxibustion oder für eine multimodale komplementäre Mind-Body-Therapie zur Verbesserung der Lebensqualität. Weitere komplementärmedizinische Verfahren konnten damals aufgrund einer unzureichenden Datenlage nicht empfohlen werden. In der nun erfolgten Leitlinienaktualisierung hat der Stellenwert komplementärmedizinischer Behandlungsverfahren weiter zugenommen. Neue hochwertige kontrolliert-randomisierte Studien ermöglichten die Ergänzung der bereits vorhandenen Empfehlungen um weitere komplementärmedizinische Therapieverfahren [3–5] : Yoga (Empfehlung 6.2.6) und ein pflanzliches Kombinationspräparat aus Myrrhe, Kamillenblütenextrakt und Kaffeekohle (Empfehlung 6.2.10) – für das es in Deutschland ein zugelassenes traditionelles Arzneimittel gibt – können nun leitlinienkonform komplementär in der Behandlung eingesetzt werden. Innerhalb des Unterkapitels «Mind-Body Verfahren» wird weiterhin auch die Lebensstilmodifikation thematisiert – ein besonders vielversprechender Therapieansatz, da er eine Vielzahl von Ansätzen aus der Komplementärmedizin enthält. Die Ziele umfassender Lebensstilmodifikationsprogramme ist bzw. wären die Entwicklung eines eigenverantwortlichen und gesundheitsfördernden Lebensstils sowie das Erlernen von Selbsthilfestrategien. Vor allem kann so eine Verbesserung der Lebensqualität und der psychischen Gesundheit erreicht werden. Für Empfehlungen weiterer komplementärmedizinischer Verfahren reicht die Datengrundlage nach wie vor nicht aus. Allerdings werden im Hintergrundtext Granatapfelextrakt, Boswellia serrata , HMPL-004 (mit Andrographis paniculata als Hauptbestandteil), Weizengrassaft, Nachtkerzenöl, Aloe-vera -Gel, Silymarin und ein Blaubeerpräparat als Published online: October 19, 2018