Randomized controlled trial of Panax ginseng in patients with irritable bowel syndrome

Abstract

The irritable bowel syndrome is defined as the presence of continuing or recurrent abdominal pain and it is associated with altered bowel habit. Experimental studies with Panax ginseng CA. Mey., Arali-aceae, have demonstrated the antinociceptive action on calcium and sodium channels, as well as on primary sensory neurons. A clinical double-blind, randomized, prospective and experimental trial was conducted for sixty days, comparing the action of dry extract of P. ginseng (300 mg/day) with trimebutine (600 mg/day). Patients were assessed at four visits for abdominal pain, using the Likert scale, and adverse events. Twenty-four patients completed the study, being 87.5% female and mean age of 47.41 years. There was improvement in abdominal pain, through Likert scale values, in patients who used P. ginseng. This group started from a median basal of −5 to 2.5, 3 and 5 in the 1st, 4th and 8th weeks of treatment, respectively, with a statistically significant difference. Similar results were achieved in those patients who used trimebutine. The only adverse effect observed was the occurrence of headache in two patients (16.66%) in the group that used the herbal. The research suggests that P. ginseng was effective in the control of abdominal pain in irritable bowel syndrome patients, analogous to trimebutin, and may be used in future studies for a better evaluation of the obtained results.

References

  1. Auricchio, M.T., Batistic-Longatoo, M.A., Nicoletti, M.A., 2007. A comparative analysis of inner wrapping and package inserts for medicines containing Panax ginseng C. A. Meyer. Cad Saúde Pública 23, 2295–2304.

    Article  Google Scholar 

  2. Akbar, A., Walters, J.R.F., Ghosh, S., 2009. Review article: visceral hypersensitivity in irritable bowel syndrome: molecular mechanisms and therapeutic agents. Aliment. Pharmacol. Ther. 30, 423–435.

    CAS  Article  PubMed  Google Scholar 

  3. Birtwhistle, R.V., 2009. Irritable bowel syndrome: are complementary and alternative medicine treatments useful? Can. Fam. Phys. 55, 126–127.

    Google Scholar 

  4. Bundy, R., Walker, A.F., Middleton, R.W., Marakis, G., Booth, J.C., 2004. Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J. Altera Complement. Med. 10, 667–669.

    Article  Google Scholar 

  5. Braga, J.E.F., Diniz, M.F.F.M., Almeida, R.N., 2010. Advances in the study of anxiolytic activity of Panax ginseng C.A. Meyer. B. Latinoamer. Caribe de Pl. 10, 491–499.

    Google Scholar 

  6. Chang, F.Y., Lu, C.L., 2009. Treatment of irritable bowel syndrome using complementary and alternative medicine. J. Chin. Med. Assoc. 72, 294–300.

    Article  PubMed  Google Scholar 

  7. Chey, W.D., Maneerattaporn, M., Saad, R., 2011. Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut Liver 5, 253–266.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Chey, W.D., Kurlander, J., Eswaran, S., 2015. Irritable bowel syndrome - a clinical review. JAMA 313, 949–958.

    CAS  Article  PubMed  Google Scholar 

  9. Choi, K.T., 2008. Botanical characteristics, pharmacological effects and medicinal components of Korean Panax ginseng CA. Meyer. Acta Pharmacol. Sin. 29, 1109–1118.

    CAS  Article  PubMed  Google Scholar 

  10. Cooke, C., Carr, I., Abrams, K., Mayberry, J., 2000. Arrowroot as a treatment for diarrhoea in irritable bowel syndrome patients: a pilot study. Arq. Gastroenterol. 37, 20–24.

    CAS  Article  PubMed  Google Scholar 

  11. Coon, J.T., Ernst, E., 2002. Panax ginseng a systematic review of adverse effects and drug interactions. Drug Saf. 25, 323–344.

    CAS  Article  PubMed  Google Scholar 

  12. Costabile, A., Kolida, S., Klinder, A., Gietl, E., Bäuerlein, M., Frohberg, C., Landschütze, V., Gibson, G.R., 2010. A double-blind, placebo-controlled, cross-over study to establish the bifidogenic effect of a very-long-chain inulin extracted from globe artichoke (Cynara scolymus) in healthy human subjects. Br. J. Nutr. 104, 1007–1017.

    CAS  Article  PubMed  Google Scholar 

  13. Dalrymple, J., Bullock, I., 2008. Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ 336, 556–558.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Emendörfer, F., Emendörfer, F., Bellato, F., Noldin, V.F., Cechinel-Filho, V., Yunes, R.A., DelleMonache, F., Cardozo, A.M., 2005. Antispasmodic activity of fractions and cynaropicrin from Cynara scoiymus on guinea-pig ileum. Biol. Pharm. Bull. 28, 902–904.

    Article  PubMed  Google Scholar 

  15. Freire, E.A.M., 2008. Avaliação da responsividade em qualidade de vida relacionada à saúde: Um estudo prospectivo em pacientes com lúpus eritematoso sistêmico [tese]. Programa de Pós-graduação em Medicina, Universidade Federal de São Paulo, São Paulo.

    Google Scholar 

  16. Guo, R., Canter, P.H., Ernst, E., 2007. A systematic review of randomised clinical trials of individualised herbal medicine in any indication. Postgrad. Med. J. 83, 633–637.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Halpert, A., Dalton, C.B., Diamant, N.E., Toner, B.B., Hu, Y., Morris, C.B., Bangdiwala, S.I., Whitehead, W.E., Drossman, D.A., 2005. Clinical response to tricyclic antidepressants in functional bowel disorders is not related to dosage. Am. J. Gastroenterol. 100, 664–671.

    CAS  Article  PubMed  Google Scholar 

  18. Hammerle, C.W., Surawicz, C.M., 2008. Updates on treatment of irritable bowel syndrome. World J. Gastroenterol. 14, 2639–2649.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. Jackson, J.L., O’Malley, P.G., Tomkins, G., Balden, E., Santoro, J., Kroenke, K., 2000. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am. J. Med. 108, 65–72.

    CAS  Article  PubMed  Google Scholar 

  20. Kiefer, D., Pantuso, T., 2003. Panax ginseng. Am. Fam. Phys. 68, 1539–1542.

    Google Scholar 

  21. Lacy, B.E., Mearin, F., Chang, L., Chey, W.D., Lembo, A.J., Simren, M., Spiller, R., 2016. Bowel disorders. Gastroenterology 150, 1393–1417.

    Article  Google Scholar 

  22. Leung, K.W., Yung, K.K., Mak, N.K., Yue, P.Y., Luo, H.B., Cheng, Y.K., Fan, T.P., Yeung, H.W., Ng, T.B., Wong, R.N., 2007. Angiomodulatory and neurological effects of ginsenosides. Curr. Med. Chem. 14, 1371–1380.

    CAS  Article  PubMed  Google Scholar 

  23. Ministério da Saúde, 2006. Política nacional de plantas medicinais e fitoterápicos, Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica, Brasília.

    Google Scholar 

  24. Ministério da Saúde, 2012. Práticas integrativas e complementares: plantas medicinais e fitoterapia na Atenção Básica, Secretariade Atenção à Saúde. Departamento de Atenção Básica, Brasília.

    Google Scholar 

  25. Mogil, J.S., Shin, Y.H., McCleskey, E.W., Kim, S.C., Nah, S.Y., 1998. Ginsenoside Rf, a trace component of ginseng root, produces antinociception in mice. Brain Res. 792, 218–228.

    CAS  Article  PubMed  Google Scholar 

  26. Nah, S., McCleskey, E.W., 1994. Ginseng root extract inhibits calcium channels in rat sensory neurons through a similar path, but different receptor, as mu-type opioids. J. Ethnopharmacol. 42, 45–51.

    CAS  Article  PubMed  Google Scholar 

  27. Nah, J.J., Hahn, J.H., Chung, S., Choi, S., Kim, Y.I., Nah, S.Y., 2000. Effect of ginsenosides, active components ofginseng, on capsaicin-induced pain-related behavior. Neuropharmacology 39, 2180–2184.

    CAS  Article  PubMed  Google Scholar 

  28. Radad, K., Gille, G., Liu, L., Rausch, W.D., 2006. Use of ginseng in medicine with emphasis on neurodegenerative disorders. J. Pharmacol. Sci. 100, 175–186.

    CAS  Article  PubMed  Google Scholar 

  29. Ramarao, P., Bhargava, H.N., 1990. Antagonism of the acute pharmacological actions of morphine by Panax ginseng extract. Gen. Pharmacol. 21, 877–880.

    CAS  Article  PubMed  Google Scholar 

  30. Rhim, H., Kim, H., Lee, D.Y., Oh, T.H., Nah, S.Y., 2002. Ginseng and ginsenoside Rg3, a newly identified active ingredient of ginseng, modulate Ca2+ channel currents in rat sensory neurons. Eur. J. Pharmacol. 436, 151–158.

    CAS  Article  PubMed  Google Scholar 

  31. Saito, Y.A., Schoenfeld, P., Locke, G.R., 2002. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am. J. Gastroenterol. 97, 1910–1915.

    PubMed  Google Scholar 

  32. Schang, J.C., Devroede, G., Pilote, M., 1993. Effects of trimebutine on colonic function in patients with chronic idiopathic constipation: evidence for the need of a physiologic rather than clinical selection. Dis. Colon Rectum. 36, 330–336.

    CAS  Article  PubMed  Google Scholar 

  33. Shergis, J.L., Zhang, A.L., Zhou, W., Xue, C.C., 2013. Panax ginseng in randomised controlled trials: a systematic review. Phytother. Res. 27, 949–965.

    Article  PubMed  Google Scholar 

  34. Shin, Y., Jung, O., Nah, J., Nam, K., Kim, C., Nah, S., 1999. Ginsenosides that produce differential antinociception in mice. Gen. Pharmacol. 32, 653–659.

    CAS  Article  PubMed  Google Scholar 

  35. Valenzuela, J., Alvarado, J., Cohen, H., Damião, A., Francisconi, C., Frugone, L., González, J.C., Hernández, A., Iade, B., Itaqui Lopes, M.H., Latorre, R., Prado, J., Moraes-Filho, P., Schmulson, M., Soifer, L., Valdovinos, M.A., Vesco, E., Zalar, A., 2004. Un consenso latinoamericano sobre el síndrome del intestino irritable. Gastroenterol. Hepatol. 27, 325–343.

    CAS  Article  PubMed  Google Scholar 

  36. Voces, J., Oliveira, A.C.C., Prieto, J.G., Vila, L., Perez, A.C., Duarte, I.D.G., Alvarez, A.I., 2004. Ginseng administration protects skeletal muscle from oxidative stress induced by acute exercise in rats. Braz. J. Med. Biol. Res. 37, 1863–1871.

    CAS  Article  PubMed  Google Scholar 

  37. WHO, 2001. Monographs on Selected Medicinal Plants. World Health Organization, Geneva.

    Google Scholar 

  38. Yoon, M.H., Kim, W.M., Lee, H.G., Choi, J.L., Kim, Y.O., Song, J.A., 2010. Analgesic effect of intrathecal ginsenosides in a murine bone cancer pain. Korean J. Pain 23, 230–235.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Margareth F. F. M. Diniz.

Additional information

Authors’ contributions

TVR and FJFN contributed to collecting and performing lab work. HACR, supervised the laboratory work and contributed writing the manuscript. JMD and MFFMD contributed to the design of the study. LCSM co-contributed to the critical statistical analysis of the study. All authors read the final manuscript and approved the submission.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rocha, H.A.C., Rocha, T.V., Nóbrega, F.J.F. et al. Randomized controlled trial of Panax ginseng in patients with irritable bowel syndrome. Rev. Bras. Farmacogn. 28, 218–222 (2018). https://doi.org/10.1016/j.bjp.2018.02.007

Download citation

Keywords

  • Ginsenosides irritable bowel syndrome
  • Pharmacological treatment