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Yesterday when I went to a health food store, I saw a lot of herbal medicines for improving the health of the gastrointestinal tract. Are these remedies effective and safe?

Dr. Brown: Herbal medicines have been used for centuries to treat functional bowel diseases. Recently Western literature has begun to publish studies of these treatments. One of the earliest studies was published in 1998 by a group from Australia. This was the first completed clinical trial concerning Chinese herbal medicine in the management of IBS published in non-Chinese literature. The researchers examined individual Chinese herbal medicines that were tailored to the patient’s specific complaints, standardized Chinese herbal medication (which involves a standard formula specifically for patients with functional bowel diseases regardless of their symptoms, and placebo medications. The standardized Chinese herbal medications contained up to 40 different herbs specifically selected by the herbalist to treat functional bowel disease. The 116 patients demonstrated a statistically superior benefit in overall symptom improvement for both the standardized and individualized Chinese herbal formulations. There was no difference between the efficacy of the individual Chinese herbal medicine and the standardized formula. However, the duration of improvement was more durable lasting in the individualized medication. A more recent study from the Chinese University of Hong Kong, published in 2006, studied 119 patients who were randomized to receive either traditional Chinese medicine and or a placebo for the treatment of the their diarrhea-predominant IBS. The investigators in this trial examined global symptom improvement, a generalized assessment of the patient’s overall well-being during the clinical trial. This is a very typical endpoint for many clinical trials completed in the field of functional bowel disease. This particular study did not show a difference in the responses between the patients in the placebo arm and those patients receiving the traditional Chinese medicine. The authors of this clinical trial concluded that Chinese herbal medicine was not effective in controlling the symptoms of diarrhea-predominant IBS. Tongxieyalfang (TXYF) is another Chinese herbal medicine that is used to manage IBS. In May 2006 the Journal of Alternative and Complementary Medicine published a study that reviewed the literature identifying randomized and controlled trials of this Chinese herbal medicine in the treatment of IBS. There were 12 studies containing a total of 1125 patients that were included in this review. Combining the data from the 12 studies showed that the TXYF was more effective than placebo in controlling IBS symptoms. The authors conclude that the Chinese herbal medicine TXYF might be effective in the treatment of IBS. Unfortunately, the quality of the 12 studies that examined this medication were very poor, and therefore a firm recommendation for the use of this Chinese herbal medicine could not be made. Finally, a larger review of the use of herbal medicines in the treatment of IBS was published in November 2005. In this review, authors gathered 75 randomized trials involving almost 8000 participants with IBS. Only three trials were considered to be of high quality, and the remaining 72 were felt to be low quality. Seventy-one different herbal medications were tested in these trials. The trials either compared the herbal remedies with placebo or were added to conventional therapies. When the herbal remedies were compared to placebo in these trials, the following herbal medicines showed a statistically significant improvement in the patient’s over all symptoms: STW–5 and STW–5–II; Tibetan herbal medicine; Padma Lax; traditional Chinese formula; and Tanxie, Yaofang and Ayurdyvic preparations. No adverse reactions from herbal medications were reported in the studies. The conclusion of this large and detailed review was that some herbal medications may improve the symptoms of IBS. However, as noted, the data from many clinical trials are not of very high quality. The studies did not contain many patients, and many of them lack confirming data. It is clear that herbal medications require further examination and higher-quality clinical trials. A firm recommendation regarding their use must await those tests.
2008-01-05 11:50:37


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