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Effect of Red Pepper on Symptoms of Irritable Bowel Syndrome: Preliminary Study

Digestive Diseases and Sciences volume 56, pages 3288–3295 (2011)Cite this article

Abstract

Background

Abdominal pain, that characterizes irritable bowel syndrome (IBS) together with bloating and disordered defecation, is mainly related to a visceral hypersensitivity due to an increase of TRPV1 nociceptive nerve fiber activity.

Aim

As capsaicin contained in red pepper is able to desensitize the TRPV1 fibres, we evaluated whether the red pepper oral administration can decrease the symptoms of visceral hypersensitivity in IBS patients.

Methods

The study was performed on 50 patients with IBS diagnosed following Rome II criteria. After a 2-week washout period, 23 patients were planned to receive 4 pills/day, for 6 weeks randomly and in a double blind manner, each containing 150 mg of red pepper powder with a coat that dissolves in the colon, and 27 patients placebo. The patients scored each day in a diary the abdominal pain and bloating intensities following the 5-point Likert scale. The weekly symptom mean scores and the final patient subjective evaluation on treatment effectiveness were statistically compared among groups and intra-groups with appropriate tests.

Results

Eight patients dropped from the study: 6 in the red pepper group for abdominal pain and 2 in the placebo group. In 8 patients, the pills were reduced to 2/day, because of the abdominal pain at the onset of treatment. The intra-group comparisons showed that in patients taking red pepper the abdominal pain and bloating mean score values of the last weeks of treatment were significantly improved with respect to pre-treatment values, unlike patients taking placebo. The final patient subjective evaluation on the treatment effectiveness showed that red pepper group scored significantly better than placebo.

Conclusions

The results of this preliminary study indicate that the chronic administration of red pepper powder in IBS patients with enteric-coated pills was significantly more effective than placebo in decreasing the intensity of abdominal pain and bloating and was considered by the patients more effective than placebo.

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References

  1. Grundmann O, Yoon SL. Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners. J Gastroenterol Hepatol. 2010;25:691–699.

    PubMed  Article  Google Scholar 

  2. Talley NJ, Zinsmeister AR, Van Dyke C, et al. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991;101:927–934.

    PubMed  CAS  Google Scholar 

  3. Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992;304:87–90.

    PubMed  Article  CAS  Google Scholar 

  4. Drossman DA, Camilleri M, Mayer EA, et al. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108–2131.

    PubMed  Article  Google Scholar 

  5. Whitehead WE, Burnett CK, Cook EW III, et al. Impact of irritable bowel syndrome on quality of life. Dig Dis Sci. 1996;41:2240–2253.

    Article  Google Scholar 

  6. Thompson WG, Longstreth GF, Drossman DA, et al. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:1143–1147.

    Google Scholar 

  7. Sandler RS, Drossman DA, Nathan HP, et al. Symptom complaints and health care seeking behaviour in subjects with bowel dysfunction. Gastroenterology. 1984;87:314–318.

    PubMed  CAS  Google Scholar 

  8. Spiegel BM, Grainek IM, Bolus R, et al. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004;164:1773–1780.

    PubMed  Article  Google Scholar 

  9. Delvaux M. Role of visceral sensitivity in the pathophysiology of irritable bowel syndrome. Gut. 2002;51:167–171.

    Article  Google Scholar 

  10. Lembo NaliboffB, Munakata J, et al. Symptoms and visceral perception in patients with pain-predominant irritable bowel syndrome. Am J Gastroenterol. 1999;94:1320–1326.

    PubMed  Article  CAS  Google Scholar 

  11. Mertz H, Naliboff B, Munakata J, et al. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995;109:40–52.

    PubMed  Article  CAS  Google Scholar 

  12. Baron R. Neuropathic pain: a clinical prospective. Handb Exp Pharmacol. 2009;194:3–30.

    PubMed  Article  CAS  Google Scholar 

  13. Spiller RC. Postinfectious irritable bowel syndrome. Gastroenterology. 2003;124:1662–1671.

    PubMed  Article  Google Scholar 

  14. Gwee KA, Graham C, McKendick MW, et al. The role of psychological and biological factors in postinfective gut dysfunction. Gut. 1999;44:400–406.

    PubMed  Article  CAS  Google Scholar 

  15. Chadwick VS, Chen W, Shu D, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology. 2002;122:1778–1783.

    PubMed  Article  Google Scholar 

  16. Hasler WI. Visceral analgesia: an emerging concept for managing functional gastrointestinal disease. Gastroenterology. 1998;115:1023–1029.

    PubMed  Article  CAS  Google Scholar 

  17. Holzer P, Holzer-Petche U. Pharmacology of inflammatory pain: local alteration in receptors and mediators. Dig Dis. 2009;27:24–30.

    PubMed  Article  Google Scholar 

  18. Manthy PW, Hunt SP. Hot pepper and pain. Neuron. 1998;21:644–645.

    Google Scholar 

  19. Buck HS, Burks TF. The neuropharmacology of capsaicin: review of some recent observations. Pharmacol Rev. 1986;38:179–226.

    PubMed  CAS  Google Scholar 

  20. Gunthorpe MJ, Szallasi A. Peripheral TRPV1 receptors as targets for drug development: new molecule and mechanisms. Curr Pharm Des. 2008;14:32–41.

    PubMed  Article  CAS  Google Scholar 

  21. Lynn B. Capsaicin: actions on nociceptive C-fibres and therapeutic potential. Pain. 1990;41:61–69.

    PubMed  Article  CAS  Google Scholar 

  22. Holzer P. Capsaicin: cellular targets, mechanism of action, and selectivity for thin sensory neurons. Pharmacol Rev. 1991;43:143–201.

    PubMed  CAS  Google Scholar 

  23. Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology. 1994;107:271–293.

    PubMed  CAS  Google Scholar 

  24. Christianson JA, Mcllwrath SL, Koeber HR, et al. Transient receptor potential vaniloid 1-immunopositive neurons in the mouse are more prevalent within colon afferent compared to skin and muscle afferent. Neurosciences. 2006;140:247–257.

    Article  CAS  Google Scholar 

  25. Jones RCW III, Xu L, Gebhart GF. The mechanosensitivity of mouse colon afferent fibres and their sensitization by inflammatory mediators require transient receptor potential vanilioid 1 and acid-sensing ion channel 3. Neurosciences. 2005;25:10981–10989.

    CAS  Google Scholar 

  26. Watson CP, Tyler KL, Bickers DR, et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther. 1993;15:510–525.

    PubMed  CAS  Google Scholar 

  27. Epstein JB, Marcoe JH. Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia. Oral Surg Oral Med Oral Pathol. 1994;77:135–140.

    PubMed  Article  CAS  Google Scholar 

  28. Sicuteri F, BM FuscoB, Marabini S, et al. Beneficial effect of capsaicin application to the nasal mucosa in cluster headache. Clin J Pain. 1989;5:49–53.

    PubMed  Article  CAS  Google Scholar 

  29. The Capsaicin Study Group. Treatment of painful diabetic neuropathy with topical capsaicin. A multicenter, double-blind, vehicle-controlled study. Arch Intern Med. 1991;151:2225–2229.

    Article  Google Scholar 

  30. Barbanti G, Maggi CA, Beneforti P, et al. Relief of pain following intravescical capsaicin in patients with hypersensitive disorders of the lower urinary tract. Br J Urol. 1993;71:686–691.

    PubMed  Article  CAS  Google Scholar 

  31. Rodriguez-Stanley S, Collings KL, Robinson M, et al. The effects of capsaicin on reflux, gastric emptying and dyspepsia. Aliment Pharmacol Ther. 2000;14:129–134.

    PubMed  Article  CAS  Google Scholar 

  32. Bortolotti M, Coccia G, Grossi G. Red pepper and functional dyspepsia. N Eng J Med. 2002;346:947–948.

    Article  Google Scholar 

  33. Quigley EM. From coming relief to real understanding; how intestinal gas causes symptoms. Gut. 2003;52:1659–1661.

    PubMed  Article  CAS  Google Scholar 

  34. Lee KJ, Kim JH, Cho SW. Relationship of underlying abnormalities in rectal sensitivity and compliance to distension with symptoms in irritable bowel syndrome. Digestion. 2006;73:133–141.

    PubMed  Article  Google Scholar 

  35. Szallasi A, Nilsson S, Farkas-Szallasi T, et al. Vanilloid (capsaicin) receptors in the rat: distribution in the brain, regional differences in the spinal cord, axonal transport to the periphery, and depletion by systemic vanilloid treatment. Brain Res. 1995;703:175–183.

    PubMed  Article  CAS  Google Scholar 

  36. Gonlachanvit S, Mahayosnond A, Kullavanijaya P. Effect of chili on postprandial gastrointestinal symptoms in diarrhoea predominant irritable bowel syndrome: evidence for capsaicin-sensitive visceral nociception hypersensitivity. Neurogastroenterol Motil. 2009;21:23–32.

    PubMed  Article  CAS  Google Scholar 

  37. Barbara G, De Giorgio R, Stanghellini V, et al. A role for inflammation in irritable bowel syndrome. Gut. 2002;51:141–144.

    Article  Google Scholar 

  38. Akbar A, Yiangou FacerP, et al. Increased capsaicin receptors TRV1-expressing sensory fibres in irritable bowel syndrome e and their correlation with abdominal pain. Gut. 2008;57:923–929.

    PubMed  Article  CAS  Google Scholar 

  39. Szallasi A, Blumberg PM. Vaniloid (Capsaicin) receptors and mechanisms. Pharmacol Rev. 1999;51:159–212.

    PubMed  CAS  Google Scholar 

  40. Yiangon Y, Facer P, Dyer NH, et al. Vanilloid receptor 1 immunoreactivity in inflamed human bowel. Lancet. 2001;35:1338–1339.

    Article  Google Scholar 

  41. Kreis ME, Haupt W, Kirkup AJ, et al. Histamine sensitivity of mesenteric afferent nerves in the rat jejunum. Am J Physiol. 1998;275:G675–G680.

    PubMed  CAS  Google Scholar 

  42. Kirkup AJ, Jiang W, Bunnet NW, et al. Stimulation of proteinase-activated receptor 2 excites jejunal afferent nerves in anaesthetised rats. J Physiol. 2003;552:89–601.

    Article  Google Scholar 

  43. Premkumar LS, Ahem GP. Induction of vaniloid receptor channel activity by protein kinase C. Nature. 2000;408:985–990.

    PubMed  Article  CAS  Google Scholar 

  44. Sugiuar T. Bielefeldt k, Gebhart GF. TRPV1 function in mouse colon sensory neurons is enhanced by metabotropic 5-hydroxythryptamine receptor activation. J Neurosci. 2004;24:9521–9530.

    PubMed  Article  Google Scholar 

  45. Barbara G, Wang B, Stanghellini V, et al. Mast cell dependent excitation of visceral nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–37.

    PubMed  Article  CAS  Google Scholar 

  46. Stead RH, Dixon MF, Bramwell NH, et al. Mast cells are closely apposed to nerves in the human gastrointestinal mucosa. Gastroenterology. 1989;97:575–585.

    PubMed  CAS  Google Scholar 

  47. Jones RCW III, Otsuka E, Vagstrom E, et al. Short-term sensitization of colon mechanoreceptors is associated with long-term hypersensitivity to colon distension in the mouse. Gastroenterology. 2007;133:184–194.

    PubMed  Article  Google Scholar 

  48. Kimbal ES, Fallace NH, Schneider CR, et al. Vanilloid receptor 1 antagonists attenuate disease severity in dextran sulphate sodium induced colitis in mice. Neurogastroenterol Motil. 2004;15:811–818.

    Article  Google Scholar 

  49. Kihara N, de la Fuente SG, Fujino K, et al. Vanilloid receptor 1 containing primary sensory neurones mediate dextran sulphate sodium induced colitis in rats. Gut. 2003;52:713–719.

    PubMed  Article  CAS  Google Scholar 

  50. Vinston J, Shenoy M, Medly D, et al. The vanilloid receptor initiates and maintains colonic hypersensitivity induced by neonatal colon irritation in rats. Gastreoenterology. 2007;132:615–627.

    Article  Google Scholar 

  51. Cavagnaro J, Lewis RM. Bidirectional regulatory circuit between the immune and neuroendocrine system. Year Immunol. 1989;4:241–252.

    PubMed  CAS  Google Scholar 

  52. Mori N, Suzuki R, Furuno T, et al. Nerve-mast cell (RBL) interaction: RBL membrane ruffling occurs at the contact site with an activated neurite. Am J Physiol Cell Physiol. 2002;283:C1738–C1744.

    PubMed  CAS  Google Scholar 

  53. Shanahan F, Denburg JA, Fiox J, et al. Mast cell heterogeneity: effects of neuroenteric peptides on histamine release. J Immunol. 1985;135:1331–1337.

    PubMed  CAS  Google Scholar 

  54. Barbara G, Stanghellini V, De Giorgio R, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126:693–702.

    PubMed  Article  Google Scholar 

  55. Geppetti P, Capone JG, Trevisani M, et al. CGRP and migraine: neurogenic inflammation revisited. J Headache Pain. 2005;6:61–70.

    PubMed  Article  Google Scholar 

  56. Cenac N, Andrews CN, Holzhausen M, et al. Role for protease activity in visceral pain in irritable bowel syndrome. J Clin Invest. 2007;117:636–647.

    PubMed  Article  CAS  Google Scholar 

  57. Klooker TK, Kuiken SD, Lei A, et al. Effect of long-term treatment with octreotide on rectal sensitivity in patients with non-constipated irritable bowel syndrome. Aliment Pharmacol Ther. 2007;15(26):605–615.

    Article  Google Scholar 

  58. Macsharry J, O’Mahony L, Fanning A, et al. Mucosal cytokine imbalance in irritable bowel syndrome. Scand J Gastroenterol. 2008;43:1467–1476.

    PubMed  Article  CAS  Google Scholar 

  59. Barbara G, Stanghellini V, Cremon C, et al. Aminosalicylates and other anti-inflammatory compounds for irritable bowel syndrome. Dig Dis. 2009;27:115–121.

    PubMed  Article  Google Scholar 

  60. Kissin I, Bright CA, Bradley EL Jr. Selective and long-standing neural blockade with resiniferatoxin prevents inflammatory pain hypersensitivity. Anaesth Analog. 2002;94:1253–1258.

    Article  CAS  Google Scholar 

  61. Szallasi A, Cruz F, Geppetti P. TRPV1: a therapeutic target for novel analgesic drugs? Trends Mol Med. 2006;12:545–554.

    PubMed  Article  CAS  Google Scholar 

  62. Holzer P. TRPV1 and the gut from a tasty receptor for a painful vanilloid to a key player in hyperalgesia. Eur J Pharmacol. 2004;500:231–241.

    PubMed  Article  CAS  Google Scholar 

  63. Bandell M, Macpherson LJ, Patapuotian A. From chills to chilis: mechanisms for thermosensation and chemesthesis via thermo TRPs. Curr Opin Neurobiol. 2007;17:490–497.

    PubMed  Article  CAS  Google Scholar 

  64. Boesmans W, Owsianik G, Tack J, et al. TRP channels in neurogastroenterology: opportunities for therapeutic intervention. Br J Pharmacol. 2011;162:18–37.

    PubMed  Article  CAS  Google Scholar 

  65. Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. J Gastroenterol Hepatol. 2009;24:1601–1607.

    PubMed  Article  Google Scholar 

  66. Perveen I, Hasan M, Masud MA, et al. Irritable bowel syndrome in a Bangladeshi urban community: prevalence and health care seeking pattern. Saudi J Gastreonterol. 2009;15:239–243.

    Article  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine and Gastroenterology, University of Bologna, Via Massarenti 48, 40138, Bologna, Italy

    M. Bortolotti

  2. Medical Department, SOFAR, Milan, Italy

    S. Porta

Authors
  1. M. Bortolotti
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  2. S. Porta
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Corresponding author

Correspondence to M. Bortolotti.

Additional information

The paper has been accepted for presentation to the Digestive Disease Week held in New Orleans, May 1–5, 2010.

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Bortolotti, M., Porta, S. Effect of Red Pepper on Symptoms of Irritable Bowel Syndrome: Preliminary Study. Dig Dis Sci 56, 3288–3295 (2011). https://doi.org/10.1007/s10620-011-1740-9

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  • DOI: https://doi.org/10.1007/s10620-011-1740-9

Keywords

  • Abdominal pain
  • Capsaicin
  • Irritable bowel syndrome
  • Red pepper
  • Visceral hypersensitivity