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Peppermint Oil for Irritable Bowel Syndrome

TO THE EDITOR: I would like to inform practicing psychiatrists about a potentially effective treatment for irritable bowel syndrome. Irritable bowel syndrome affects a fair number of patients who visit psychiatric clinics. The classic symptoms of irritable bowel syndrome symptoms are lower abdominal pain, bloating, and alteration of bowel habits. The percentage of the population of Western civilization with the symptoms of irritable bowel syndrome is between 10% and 15%.¹ Within the last 2 years, in our mood disorders clinic, 17% of the 72 patients suffering from bipolar mood disorder have reported comorbid irritable bowel syndrome, diagnosed by their internist or family physician. I began informing patients who have comorbid irritable bowel syndrome about peppermint oil, a possible remedy. Seven (of 12) patients with comorbid irritable bowel syndrome have used it and reported that they felt peppermint oil has helped relieve their irritable bowel syndrome symptoms, mainly bloating, pain, and discomfort. Patients who benefited were taking one-half to one full cc (mm) of peppermint oil in a nonalcoholic drink of their choice after breakfast and dinner.

The first report of the use of peppermint oil for relief of irritable bowel syndrome symptoms dates back to 1979.² A report³ has summarized eight randomized, controlled trials of extracts of peppermint (Mentha piperita L.) as a symptomatic treatment for irritable bowel syndrome. It noted that peppermint oil could be efficacious for symptom relief in irritable bowel syndrome. However, citing "methodological flaws associated with most studies," a definitive judgment about efficacy was not given.³ There also are reports on the use of an enteric-coated peppermint oil formulation and menthol-beta-D-glucuronide, a potential prodrug for colonic delivery of the spasmolytic agent menthol, the primary constituent of peppermint oil. In one study,⁴ 41 patients (79%) taking the formulation experienced an alleviation of the severity of abdominal pain (29 were pain-free), 43 (83%) had less abdominal distension, 43 (83%) had less stool frequency, 38 (73%) had fewer borborygmi, and 41 (79%) had less flatulence.

In a recent randomized, double-blind, controlled trial,⁵ 42 children with irritable bowel syndrome were given pH-dependent, enteric-coated peppermint oil capsules or placebo. After 2 weeks, 75% of those receiving peppermint oil had reduced pain associated with irritable bowel syndrome.

Peppermint oil may be used as a therapeutic agent during the symptomatic phase of irritable bowel syndrome.⁵ One potential scientific explanation is that peppermint oil is an inhibitor of K+ depolarization-induced and electrically stimulated responses in the ileum. Data indicate that both menthol and its constituent, peppermint oil, exert Ca₂+-channel-blocking properties that may underlie their use in irritable bowel syndrome. Ca₂+-channel antagonism may not be the only pharmacological effect of menthol and peppermint oil contributing to intestinal smooth-muscle relaxation.⁶

Many patients labeled as having irritable bowel syndrome are in fact intolerant to the ingestion of lactose-containing foods, sorbitol, fructose, and combinations of fructose and sorbitol.⁷ Gastroesophageal reflux, when comorbid with irritable bowel syndrome, is sometimes treated with the elimination of peppermint from the diet.⁷ Therefore, patients should also be seen by a gastroenterologist to help rule out lactose intolerance, gastroesophageal reflux, and the like.

REFERENCES

1. Muller-Lissner SA, Bollani S, Brummer RJ, Coremans G, Dapoigny M, Marshall JK, Muris JW, Oberndorff-Klein Wolthuis A, Pace F, Rodrigo L, Stockbrugger R, Vatn MH: Epidemiological aspects of irritable bowel syndrome in Europe and North America. Digestion 2001; 64:200-204[CrossRef][Medline]
2. Rees WD, Evans BK, Rhodes J: Treating irritable bowel syndrome with peppermint oil. Br Med J 1979; 2:835-836
3. Pittler MH, Ernst E: Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol 1998; 93:1131-1135[CrossRef][Medline]
4. Liu JH, Chen G-H, Yeh H-Z, Huang C-K, Poon S-K: Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 1997; 32:765-768[Medline]
5. Kline RM, Kline JJ, Di Palma J, Barbero GJ: Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr 2001; 138:125-128[CrossRef][Medline]
6. Hawthorn M, Ferrante J, Luchowski E, Rutledge A, Wei XY, Triggle DJ: The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations. Aliment Pharmacol Ther 1988; 2:101-118[Medline]
7. Friedman G: Nutritional therapy of irritable-bowel syndrome. Gastroenterol Clin North Am 1989; 18:513-524[Medline]

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