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.
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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.
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.
Birtwhistle, R.V., 2009. Irritable bowel syndrome: are complementary and alternative medicine treatments useful? Can. Fam. Phys. 55, 126–127.
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.
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.
Chang, F.Y., Lu, C.L., 2009. Treatment of irritable bowel syndrome using complementary and alternative medicine. J. Chin. Med. Assoc. 72, 294–300.
Chey, W.D., Maneerattaporn, M., Saad, R., 2011. Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut Liver 5, 253–266.
Chey, W.D., Kurlander, J., Eswaran, S., 2015. Irritable bowel syndrome - a clinical review. JAMA 313, 949–958.
Choi, K.T., 2008. Botanical characteristics, pharmacological effects and medicinal components of Korean Panax ginseng CA. Meyer. Acta Pharmacol. Sin. 29, 1109–1118.
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.
Coon, J.T., Ernst, E., 2002. Panax ginseng a systematic review of adverse effects and drug interactions. Drug Saf. 25, 323–344.
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.
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.
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.
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.
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.
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.
Hammerle, C.W., Surawicz, C.M., 2008. Updates on treatment of irritable bowel syndrome. World J. Gastroenterol. 14, 2639–2649.
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.
Kiefer, D., Pantuso, T., 2003. Panax ginseng. Am. Fam. Phys. 68, 1539–1542.
Lacy, B.E., Mearin, F., Chang, L., Chey, W.D., Lembo, A.J., Simren, M., Spiller, R., 2016. Bowel disorders. Gastroenterology 150, 1393–1417.
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.
Ministério da Saúde, 2006. Política nacional de plantas medicinais e fitoterápicos, Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica, Brasília.
Ministério da Saúde, 2012. Práticas integrativas e complementares: plantas medicinais e fitoterapia na Atenção Básica, Secretariade Atenção à Saúde. Departamento de Atenção Básica, Brasília.
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.
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.
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.
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.
Ramarao, P., Bhargava, H.N., 1990. Antagonism of the acute pharmacological actions of morphine by Panax ginseng extract. Gen. Pharmacol. 21, 877–880.
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.
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.
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.
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.
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.
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.
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.
WHO, 2001. Monographs on Selected Medicinal Plants. World Health Organization, Geneva.
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.
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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.
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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
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DOI: https://doi.org/10.1016/j.bjp.2018.02.007